Individual
EBONY DECHELLE WIGGINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
681 COTTAGE ST NE, SALEM, OR 97301-2419
(336) 314-7105
Mailing address
681 COTTAGE ST NE, SALEM, OR 97301-2419
(336) 314-7105
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/23/2024
Last updated
10/23/2024
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