Provider Demographics
NPI:1386803393
Name:WIGGIN, MALLENE PEACE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MALLENE
Middle Name:PEACE
Last Name:WIGGIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:THE LISTENING CENTER AT JOHNS HOPKINS
Mailing Address - Street 2:601 N. CAROLINE ST. SUITE 6102
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0001
Mailing Address - Country:US
Mailing Address - Phone:410-955-9397
Mailing Address - Fax:410-614-9167
Practice Address - Street 1:THE LISTENING CENTER AT JOHNS HOPKINS
Practice Address - Street 2:601 N. CAROLINE ST. SUITE 6102
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:410-955-9397
Practice Address - Fax:410-614-9167
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-8903 (4645883)235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist