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General NPI Number Information
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NPI Number | 1295102929
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Entity Type | Individual
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Provider Name | BONNIE WILKES
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Gender | Female
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 650 HOWE AVE BUILDING 400B
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City | SACRAMENTO
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State | CA
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Zip | 95825-4731
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Country | US
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Telephone | 916-441-0123
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Fax |
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Provider Business Mailing Address
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Address Line | 401 12TH ST
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City | MARYSVILLE
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State | CA
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Zip | 95901-4805
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Country | US
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Telephone | 530-315-9037
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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