| Doctor Name: | JOLENE PEGGY WIRKUS |
| NPI Number: | 1497996052 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | LP5052 |
| Business Practice Address: | 9 4th Street Windom, MN - 56101 |
| Business Phone Number: | 5078312090 |
| Business Fax Number: | 5078310185 |
| Mailing Address: | 216 E Luverne St, Po Box 686 LUVERNE |
| State: | MN |
| Postal Code: | 561561610 |
| Phone Number: | 5072839511 |
| Fax Number: | 5072839511 |
| NPI Enumeration Date: | 03/11/2009 |
| NPI Last Update Date: | 03/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | LP5052 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |