Provider Demographics
NPI:1902053150
Name:WIGGERS, BRIDGETTE M (PHD)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:M
Last Name:WIGGERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8819 COMMONS BLVD # 101
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2177
Mailing Address - Country:US
Mailing Address - Phone:330-425-2212
Mailing Address - Fax:330-425-2779
Practice Address - Street 1:8819 COMMONS BLVD # 100
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2177
Practice Address - Country:US
Practice Address - Phone:330-425-2212
Practice Address - Fax:330-425-2779
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6447103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent