Lori Ab Wiggenhorn, MA, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP3703 Issued in MN

Practice address

3640 Talmage Cir Ste 205
Vadnais Heights, MN 55110-4184

Phone

(612) 388-5236

Fax

(612) 326-3359

NPI assigned

Sep 21, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550534400000",
    "number": "1013015940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3640 TALMAGE CIR STE 205",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551104184",
            "telephone_number": "612-388-5236",
            "fax_number": "612-326-3359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3640 TALMAGE CIR STE 205",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551104184",
            "telephone_number": "612-388-5236",
            "fax_number": "612-326-3359"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3640 Talmage Cir Ste 210",
            "address_purpose": "LOCATION",
            "city": "Vadnais Heights",
            "state": "MN",
            "postal_code": "551107100",
            "country_code": "US",
            "telephone_number": "612-388-5236",
            "fax_number": "612-326-3359",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIGGENHORN",
        "first_name": "LORI",
        "middle_name": "AB",
        "credential": "MA, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2019-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200731439",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Vadnais Heights, MN
• Providers in Vadnais Heights, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.