Healthcare Provider Details

I. General information

NPI: 1417269796
Provider Name (Legal Business Name): ANN MARIE BACHMANN MSW, LCSW, EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 W MAIN ST SUITE 201
BELLEVILLE IL
62223-1719
US

IV. Provider business mailing address

8601 W MAIN ST SUITE 201
BELLEVILLE IL
62223-1719
US

V. Phone/Fax

Practice location:
  • Phone: 618-394-5900
  • Fax: 618-394-5909
Mailing address:
  • Phone: 618-394-5900
  • Fax: 618-394-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002566
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: