| Doctor Name: | ANDREA NICOLE WILKE |
| NPI Number: | 1124376884 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FDC |
| License Number: | |
| Business Practice Address: | 9393 Glen Arbor Rd Ben Lomond, CA - 950059631 |
| Business Phone Number: | 8313362932 |
| Business Fax Number: | 8313362932 |
| Mailing Address: | 9393 Glen Arbor Rd, BEN LOMOND |
| State: | CA |
| Postal Code: | 950059631 |
| Phone Number: | 8313362932 |
| Fax Number: | 8313362932 |
| NPI Enumeration Date: | 08/28/2012 |
| NPI Last Update Date: | 08/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YS0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |