Provider Demographics
NPI:1780994863
Name:DR BONNIE WAGNER
Entity type:Organization
Organization Name:DR BONNIE WAGNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER WIKLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:559-234-2239
Mailing Address - Street 1:PO BOX 1437
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-8237
Mailing Address - Country:US
Mailing Address - Phone:559-234-2239
Mailing Address - Fax:559-234-2239
Practice Address - Street 1:194 E ELM AVE
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-2800
Practice Address - Country:US
Practice Address - Phone:559-234-2239
Practice Address - Fax:559-234-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty