Individual
GREGORY N WIERSEMA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MST-CCC/A
Contact information
Practice address
221 FOND DU LAC AVE, FOND DU LAC, WI 54935-5303
(920) 923-4678
(920) 923-4678
Mailing address
221 FOND DU LAC AVE, FOND DU LAC, WI 54935-5303
(920) 923-4678
(920) 923-4678
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
55-156
WI
237600000X
Audiologist-Hearing Aid Fitter
55-156
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41105900
—
WI
Enumeration date
06/21/2005
Last updated
09/11/2025
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