1740478353 NPI number — MRS. ELLEN FORD WIGGINS MSW, LICSW

Table of content: MRS. ELLEN FORD WIGGINS MSW, LICSW (NPI 1740478353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740478353 NPI number — MRS. ELLEN FORD WIGGINS MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIGGINS
Provider First Name:
ELLEN
Provider Middle Name:
FORD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740478353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8913 LOUGHRAN TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WASHINGTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20744-5639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-253-4636
Provider Business Mailing Address Fax Number:
301-203-8683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 MISSISSIPPI AVE SE
Provider Second Line Business Practice Location Address:
SUITE #104
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20020-6117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-436-3060
Provider Business Practice Location Address Fax Number:
202-610-9522
Provider Enumeration Date:
10/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LC301853 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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