Individual
KENNETH WIGGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
3050 S NATIONAL AVE, SUITE 104, SPRINGFIELD, MO 65804-4242
(417) 597-4572
(417) 882-1507
Mailing address
3050 S NATIONAL AVE, SUITE 104, SPRINGFIELD, MO 65804-4242
(417) 597-4572
(417) 882-1507
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2005024468
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
497430306
—
MO
Enumeration date
02/12/2007
Last updated
08/16/2016
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