Mathijs Jonathan Laurens Dijkstra

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

20301-130 Issued in WI

Practice address

220 Washington Ave
Oshkosh, WI 54901-5030

Phone

(920) 236-4700

NPI assigned

Feb 23, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of Winnebago

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Oshkosh, WI
  • NPI 1508960675
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1811753221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 WASHINGTON AVE",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549015030",
            "telephone_number": "920-236-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 WASHINGTON AVE",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549015030",
            "telephone_number": "920-236-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIJKSTRA",
        "first_name": "MATHIJS",
        "middle_name": "JONATHAN LAURENS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-23",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "20301-130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna L Devries, CRNA
• Amy Kathleen Dice, PMHNP
• Kristin Diedrich, PTA
• Digestive Healthcare Specialists, SC
• Kevin Dihel
• Brittany DO-McKenzie, PA
• Robert Scott Dohe, H.I.S.
• Richard Andrew Domiter, RN
• Shaun Donohue
• James R Donovan

• Addiction (Substance Use Disorder) Counselor in Oshkosh, WI
• Providers in Oshkosh, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 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.

Verify at the official NPI Registry.