Provider Demographics
NPI:1679373005
Name:WIGERT, JULIA SUZANNE
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:SUZANNE
Last Name:WIGERT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 N SHERMAN ST
Mailing Address - Street 2:STE 200 # 2011
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203
Mailing Address - Country:US
Mailing Address - Phone:720-282-9612
Mailing Address - Fax:
Practice Address - Street 1:500 KIMBARK ST STE 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5585
Practice Address - Country:US
Practice Address - Phone:303-651-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0022547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health