Provider Demographics
NPI:1609630979
Name:WILGUS, LAUREN E
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:WILGUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E FRONT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4731
Mailing Address - Country:US
Mailing Address - Phone:406-670-2271
Mailing Address - Fax:
Practice Address - Street 1:519 E FRONT ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4794
Practice Address - Country:US
Practice Address - Phone:406-560-0894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT171400000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach