Healthcare Provider Details

I. General information

NPI: 1619263621
Provider Name (Legal Business Name): HOLLIE BAHEN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CABARRUS AVE E
CONCORD NC
28025-3699
US

IV. Provider business mailing address

101 CABARRUS AVE E
CONCORD NC
28025-3699
US

V. Phone/Fax

Practice location:
  • Phone: 888-849-7379
  • Fax: 855-857-7333
Mailing address:
  • Phone: 888-849-7379
  • Fax: 855-857-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3951
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number12931
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: