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General NPI Number Information
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NPI Number | 1922924935
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Entity Type | Individual
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Provider Name | BONNIE R WILSON CDPT.CO.61645756
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Gender | Female
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | 1906 N 20TH AVE
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City | PASCO
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State | WA
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Zip | 99301-3393
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Country | US
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Telephone | 509-792-1041
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 W ENTIAT AVE APT A101
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City | KENNEWICK
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State | WA
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Zip | 99336-3489
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDPT.CO.61645756
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License Number State | WA
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