Provider Demographics
NPI:1063926442
Name:WIGEN, JENNIFER SUE (SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUE
Last Name:WIGEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:SUE
Other - Last Name:STAPLETON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:14308 E BELMONT RD
Mailing Address - Street 2:
Mailing Address - City:MICA
Mailing Address - State:WA
Mailing Address - Zip Code:99023-9607
Mailing Address - Country:US
Mailing Address - Phone:509-389-0647
Mailing Address - Fax:
Practice Address - Street 1:14308 E BELMONT RD
Practice Address - Street 2:
Practice Address - City:MICA
Practice Address - State:WA
Practice Address - Zip Code:99023-9607
Practice Address - Country:US
Practice Address - Phone:509-389-0647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI60799114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist