Provider Demographics
NPI:1902609019
Name:WIGGINS, AMANDA MICHELLE (CMA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELLE
Last Name:WIGGINS
Suffix:
Gender:
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 SOUTHGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-3024
Mailing Address - Country:US
Mailing Address - Phone:740-781-0320
Mailing Address - Fax:740-781-0336
Practice Address - Street 1:1750 SOUTHGATE PKWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3024
Practice Address - Country:US
Practice Address - Phone:740-781-0320
Practice Address - Fax:740-781-0336
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator