MEDICARE: MRS. LORI NORTHCUTT WIGGINTON BEHAVIOR ANALYST

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
1	103K00000X	Behavior Analyst		TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790953677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI NORTHCUTT WIGGINTON BEHAVIOR ANALYST

Provider Business Mailing Address
First Line	:	2942 BUCKNER LN
Second Line	:
City	:	SPRING HILL
State	:	TN
Zip	:	37174-2854
Country	:	US
Telephone Number	:	615-519-7799
Fax Number	:

Provider Business Practice Location Address
First Line	:	2942 BUCKNER LN
Second Line	:
City	:	SPRING HILL
State	:	TN
Zip	:	37174-2854
Country	:	US
Telephone Number	:	615-519-7799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	10/20/2011

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