Healthcare Provider Details

I. General information

NPI: 1881503795
Provider Name (Legal Business Name): MARISSA WINGERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W 16TH ST
WELLINGTON KS
67152-8125
US

IV. Provider business mailing address

1526 E 13TH AVE
WINFIELD KS
67156-4606
US

V. Phone/Fax

Practice location:
  • Phone: 620-326-7448
  • Fax:
Mailing address:
  • Phone: 620-222-4235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC02039TS
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: