Wiersema, Gregory N

Wiersema, Gregory N is an individual health care provider with primary practice located at 221 Fond Du Lac Ave , Fond Du Lac WI 54935-5303. He recently has 2 registered licenses in different health care specialties including Speech, Language and Hearing Service Providers / Audiologist, Speech, Language and Hearing Service Providers / Audiologist-Hearing Aid Fitter. Speech, Language and Hearing Service Providers / Audiologist is his primary health care specialty. Wiersema, Gregory N can be contacted via phone (920) 923-4678.

Contact Information

Primary practice address
221 Fond Du Lac Ave Fond Du Lac WI 54935-5303
Phone: (920) 923-4678
Fax: (920) 923-4678
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Audiologist 231H00000X 55-156 Wisconsin
Speech, Language and Hearing Service Providers / Audiologist-Hearing Aid Fitter 237600000X 55-156 Wisconsin

Profile Details

NPI number 1831195361
LBN Legal business name Wiersema, Gregory N
Credentials MST-CCC/A
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 21st, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831195361 NPPES
Wisconsin MEDICAID 41105900

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