Individual
DR. BONNIE WAGONER ISACKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
201 PENN CENTER BLVD, SUITE 555, PITTSBURGH, PA 15235-5442
(412) 421-0184
(412) 261-4276
Mailing address
201 PENN CENTER BLVD, SUITE 555, PITTSBURGH, PA 15235-5442
(412) 421-0184
(412) 261-4276
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PS006785L
PA
235Z00000X
Speech-Language Pathologist
Primary
SL000239L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
743751
HIGHMARK BCBS PSYCHOLOGY
PA
Enumeration date
09/20/2006
Last updated
09/11/2025
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