Bonnie Lynne Wagner, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW20649 Issued in CA

Practice address

6765 Green Valley Rd
Placerville, CA 95667-8984

Phone

(530) 622-5551

Fax

(530) 622-5800

NPI assigned

Sep 28, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190937600000",
    "number": "1477740876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 FONG ST",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956302462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6765 GREEN VALLEY RD",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956678984",
            "telephone_number": "530-622-5551",
            "fax_number": "530-622-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "BONNIE",
        "middle_name": "LYNNE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-28",
        "last_updated": "2007-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW20649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victor R Sucheski DPM
• Lucille Goulart Villalobos, MASTERS HEALTH ADMIN
• Joy E. Von Astel
• Maria Elena Vongortler
• Dennis Wade, MS, SUDCC IV-CS
• Rheanna Waisner
• Zachary Jon Walder, DO
• Walgreen Co.
• Janna Wallace, RADTI
• Scott Eric Wallace, PHARMD

• Clinical Social Worker in Placerville, CA
• Providers in Placerville, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.