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NPI Code Detail

MEDICARE: ELIZABETH WIGAN BCBA

MEDICARE: ELIZABETH WIGAN BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1740637198
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH WIGAN BCBA
Provider Business Mailing Address
First Line : 1309 OAK WAY AVE
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4049
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1309 OAK WAY AVE
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4049
Country : US
Telephone Number : 720-670-9046
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2016
Last Update Date : 05/16/2016

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