Individual
DR. DAVID WIGUTOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
646 16TH ST, ASTORIA, OR 97103-3709
(503) 338-1892
Mailing address
1348 JEROME AVE, ASTORIA, OR 97103-3940
(503) 338-1892
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1451
OR
103TC0700X
Clinical Psychologist
1791
AZ
Other
Enumeration date
11/10/2008
Last updated
11/10/2008
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