Active NPI
Conrad Wynstra
- Addiction (Substance Use Disorder) Counselor
- Waukesha, WI
National Provider Identifier
1104643675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 20673-130
- Practice address
- 2422 N Grandview Blvd
Waukesha, WI 53188-6105 - Phone
- (262) 549-6600
- Fax
- (262) 549-6698
- NPI assigned
- Sep 25, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 20673-130 | WI | Primary |
Addresses
Primary practice location
2422 N Grandview Blvd
Waukesha, WI 53188-6105
Mailing address
2422 N Grandview Blvd
Waukesha, WI 53188-6105
Phone (262) 549-6600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20673-130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727222400000",
"number": "1104643675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2422 N GRANDVIEW BLVD",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531886105",
"telephone_number": "262-549-6600",
"fax_number": "262-549-6698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2422 N GRANDVIEW BLVD",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531886105",
"telephone_number": "262-549-6600",
"fax_number": "262-549-6698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNSTRA",
"first_name": "CONRAD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-09-25",
"last_updated": "2024-09-25",
"certification_date": "2024-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "20673-130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukesha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.