Individual
MR. JOHN NICHOLAS WIRKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16535 W BLUEMOUND RD, BROOKFIELD, WI 53005-5936
(262) 542-3255
(262) 821-6180
Mailing address
111 WEST ST, JOHNSON CREEK, WI 53038-9503
(920) 699-3703
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1006
WI
Other
Enumeration date
08/01/2006
Last updated
07/08/2007
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