Individual
NICHOL WIENKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
571 COUNTY ROAD A, GREEN LAKE, WI 54941-8630
(920) 294-4070
(920) 294-4139
Mailing address
571 COUNTY ROAD A, GREEN LAKE, WI 54941-8630
(920) 294-4070
(920) 294-4139
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16805-130
WI
101YP2500X
Professional Counselor
Primary
5942-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100047842
—
WI
Enumeration date
08/19/2015
Last updated
03/27/2023
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