Provider Demographics
NPI:1063225902
Name:THE WIG COLLECTIVE
Entity type:Organization
Organization Name:THE WIG COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:CPS
Authorized Official - Phone:801-899-9765
Mailing Address - Street 1:80 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3024
Mailing Address - Country:US
Mailing Address - Phone:707-761-3354
Mailing Address - Fax:
Practice Address - Street 1:3400 W MAYFLOWER WAY STE 128
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-3256
Practice Address - Country:US
Practice Address - Phone:801-899-9765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier