Active NPI
Bonnie R. Wickes, PSY.D.
- Psychologist
- Anchorage, AK
National Provider Identifier
1619036555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 517
- Practice address
- 711 H St
Suite 400
Anchorage, AK 99501-3416 - Phone
- (907) 274-1333
- Fax
- (907) 276-7004
- NPI assigned
- Dec 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 517 | AK | Primary |
Addresses
Primary practice location
711 H St
Suite 400
Anchorage, AK 99501-3416
Mailing address
711 H St
Suite 400
Anchorage, AK 99501-3416
Phone (907) 274-1333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS9863 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 517 | AK | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1619036555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 H ST",
"address_2": "SUITE 400",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995013416",
"telephone_number": "907-274-1333",
"fax_number": "907-276-7004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 H ST",
"address_2": "SUITE 400",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995013416",
"telephone_number": "907-274-1333",
"fax_number": "907-276-7004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKES",
"first_name": "BONNIE",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-06",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AK",
"license": "517",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PS9863",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.