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General NPI Number Information
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NPI Number | 1780994863
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Entity Type | Organization
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Legal Business Name | DR BONNIE WAGNER
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 194 E ELM AVE
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City | COALINGA
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State | CA
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Zip | 93210-2800
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Country | US
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Telephone | 559-234-2239
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Fax | 559-234-2239
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Provider Business Mailing Address
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Address Line | PO BOX 1437
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City | COALINGA
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State | CA
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Zip | 93210-8237
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Country | US
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Telephone | 559-234-2239
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Fax | 559-234-2239
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. BONNIE WAGNER WIKLER
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Credential | PH.D.
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Telephone | 559-234-2239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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