Individual
KIERSTYN JOHNSON-WIGFALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13900 HULL STREET RD, MIDLOTHIAN, VA 23112-2004
(804) 639-8788
Mailing address
12001 IRON BRIDGE RD, CHESTER, VA 23831-1460
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202006559
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932569712
—
VA
Enumeration date
03/07/2016
Last updated
10/11/2018
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