Provider Demographics
NPI:1871928077
Name:BICKSLER, ALLISON J (PSYD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:J
Last Name:BICKSLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:J
Other - Last Name:WAGNER-MILLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:385 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1040
Mailing Address - Country:US
Mailing Address - Phone:714-681-9070
Mailing Address - Fax:714-773-4788
Practice Address - Street 1:385 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1040
Practice Address - Country:US
Practice Address - Phone:714-681-9070
Practice Address - Fax:714-773-4788
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical