Healthcare Provider Details

I. General information

NPI: 1932408929
Provider Name (Legal Business Name): BAHN AND ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 S 7TH ST
SPRINGFIELD IL
62703-2421
US

IV. Provider business mailing address

1220 S 7TH ST
SPRINGFIELD IL
62703-2421
US

V. Phone/Fax

Practice location:
  • Phone: 217-679-5379
  • Fax: 217-679-5349
Mailing address:
  • Phone: 217-679-5379
  • Fax: 217-679-5349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3462
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3462
License Number StateCO

VIII. Authorized Official

Name: DR. SARA BAHN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 217-679-5379