MEDICARE: BONNIE BIRGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1104247352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE BIRGE

Provider Business Mailing Address
First Line	:	935 SCOTT CT
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-6430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2218 N 1ST ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-2007
Country	:	US
Telephone Number	:	408-538-0886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2013
Last Update Date	:	12/13/2013

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Directions to “ BONNIE BIRGE ” Practice Location

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