Provider Demographics
NPI:1760887772
Name:WIRKUS, TAYLOR ELISE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ELISE
Last Name:WIRKUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 1ST ST N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4000
Mailing Address - Country:US
Mailing Address - Phone:320-202-2000
Mailing Address - Fax:320-253-1684
Practice Address - Street 1:407 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8815
Practice Address - Country:US
Practice Address - Phone:763-295-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist