Individual
BRANDON R WIGBOLDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS CCC-SLP/L
Contact information
Practice address
17207 71ST AVE, TINLEY PARK, IL 60477-3303
(708) 362-4603
Mailing address
17207 71ST AVE, TINLEY PARK, IL 60477-3303
(708) 362-4603
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146011666
IL
Other
Enumeration date
12/09/2016
Last updated
12/09/2016
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