Bonita Wickstrom Inc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I4390 Issued in NM

Legal business name

BONITA WICKSTROM INC

Practice address

12836 Lomas Blvd NE
Suite B
Albuquerque, NM 87112-6210

Phone

(505) 453-7862

NPI assigned

Jun 17, 2006

Last updated

Jan 29, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bonita Wickstrom, LISWNPI 1225075161

Title

President

Phone

(505) 275-7795

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bonita Rae Wickstrom, LISW

  • Social Worker
  • Albuquerque, NM
  • NPI 1225075161
  NPD (past) Authorized official

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201564800000",
    "number": "1548205289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14507 ENCANTADO RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871232249",
            "telephone_number": "505-275-7795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12836 LOMAS BLVD NE",
            "address_2": "SUITE B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871126210",
            "telephone_number": "505-453-7862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONITA WICKSTROM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2008-01-29",
        "status": "A",
        "authorized_official_last_name": "WICKSTROM",
        "authorized_official_first_name": "BONITA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-275-7795",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "I4390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Bond, DO
• Melanie Bonds
• Rebecca Bone, PHD
• Caroline Alberta Bonham, MD
• Allean Raneta Bonin
• Carlos Jacob Bonnafoux, MD MEDICAL STUDENT
• Beverly Jean Bonnell, LPCC
• Paul Bonnell, LMSW
• Mary Kathryn Bonner, RRT
• Jana Bonnett, PHARM D

• Clinical Social Worker in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Clinical Social Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2008; 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.