Active NPI
Wendy Lyn Wick, RN,LPC,SAC
- Professional Counselor
- Brookfield, WI
National Provider Identifier
1174717094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3937-125
- Practice address
- 13035 W Bluemound Rd
Suite 100
Brookfield, WI 53005-8001 - Phone
- (262) 408-1125
- NPI assigned
- Sep 4, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3937-125 | WI | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 15465-131 | WI |
Addresses
Primary practice location
13035 W Bluemound Rd
Suite 100
Brookfield, WI 53005-8001
Mailing address
13035 W Bluemound Rd
Suite 100
Brookfield, WI 53005-8001
Phone (262) 408-1125
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174717094 | Medicaid | WI |
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15465-131 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 3937-125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258588800000",
"number": "1174717094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13035 W BLUEMOUND RD",
"address_2": "SUITE 100",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530058001",
"telephone_number": "262-408-1125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13035 W BLUEMOUND RD",
"address_2": "SUITE 100",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530058001",
"telephone_number": "262-408-1125"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICK",
"first_name": "WENDY",
"middle_name": "LYN",
"name_prefix": "Mrs.",
"credential": "RN,LPC,SAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-09-04",
"last_updated": "2009-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "3937-125",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "15465-131",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1174717094",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.