Bruce A Wilber Jr., SAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Gresham, WI
NPI 1003063157 · NPPES record last updated Aug 20, 2008
Key facts
- NPI
- 1003063157
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 15433131 (WI)
- Practice address
- N2150 Kesaehkahtek Rd
Gresham, WI 54128-9602 - Phone
- (715) 799-3835
- Fax
- (715) 799-3836
- NPI assigned
- Aug 20, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15433131 | WI | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 15433131 | WI | Yes |
Addresses
Primary practice location
N2150 Kesaehkahtek Rd
Gresham, WI 54128-9602
Mailing address
N2150 Kesaehkahtek Rd
Gresham, WI 54128-9602
Phone (715) 799-3835
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41162800 | Medicaid | WI |
Other providers in Gresham, WI
- Jennifer Mavis
- Nanette Marie Pamonicutt
- Chantelle Panske
- Brandon Waupekenay
- Maureen White
- Jennifer A Wilber
All providers in Gresham, WI · Addiction (Substance Use Disorder) Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.