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General NPI Number Information
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NPI Number | 1487137246
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Entity Type | Individual
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Provider Name | BOGUSLAWA BORNIK WILSON RMHI
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Gender | Female
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | 9050 58TH DR E
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-6104
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Country | US
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Telephone | 941-229-3507
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Fax |
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Provider Business Mailing Address
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Address Line | 14444 N BRANCH RD
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City | SARASOTA
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State | FL
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Zip | 34240-9032
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Country | US
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Telephone | 941-345-7446
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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