Individual
TIFFANY PATRICE WIGGINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
335 S LEAVITT ST, CHICAGO, IL 60612-3040
(773) 816-3304
Mailing address
335 S LEAVITT ST, CHICAGO, IL 60612-3040
(773) 816-3304
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
25281581837W
IL
Other
Enumeration date
12/23/2014
Last updated
01/03/2022
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