MEDICARE: ADRIENNE BOHLEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1942709845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE BOHLEN

Provider Business Mailing Address
First Line	:	1582 N WAGGONER RD
Second Line	:
City	:	BLACKLICK
State	:	OH
Zip	:	43004-8669
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1582 N WAGGONER RD
Second Line	:
City	:	BLACKLICK
State	:	OH
Zip	:	43004-8669
Country	:	US
Telephone Number	:	303-989-8169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2018
Last Update Date	:	04/28/2022

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Directions to “ ADRIENNE BOHLEN ” Practice Location

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