Healthcare Provider Details

I. General information

NPI: 1730206640
Provider Name (Legal Business Name): BONNIE MARIE LINQUIST CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N ACRES RD SUITE 60
PRESCOTT WI
54021-7038
US

IV. Provider business mailing address

W12187 STATE ROAD 35
PRESCOTT WI
54021-7605
US

V. Phone/Fax

Practice location:
  • Phone: 715-262-4777
  • Fax:
Mailing address:
  • Phone: 715-262-4777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number794-046
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: