Active NPI
Jolene Peggy Wirkus, PSY.D.
- Clinical Psychologist
- Windom, MN
National Provider Identifier
1497996052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP5052
- Practice address
- 9 4TH Street
Windom, MN 56101 - Phone
- (507) 831-2090
- Fax
- (507) 831-0185
- NPI assigned
- Mar 11, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP5052 | MN | Primary |
Addresses
Primary practice location
9 4TH Street
Windom, MN 56101
Mailing address
216 E Luverne St
PO Box 686
Luverne, MN 56156-1610
Phone (507) 283-9511
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP5052 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236729600000",
"number": "1497996052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "216 E LUVERNE ST",
"address_2": "PO BOX 686",
"city": "LUVERNE",
"state": "MN",
"postal_code": "561561610",
"telephone_number": "507-283-9511",
"fax_number": "507-283-9511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 4TH STREET",
"city": "WINDOM",
"state": "MN",
"postal_code": "56101",
"telephone_number": "507-831-2090",
"fax_number": "507-831-0185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIRKUS",
"first_name": "JOLENE",
"middle_name": "PEGGY",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-11",
"last_updated": "2009-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP5052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Windom, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.