Healthcare Provider Details

I. General information

NPI: 1619423324
Provider Name (Legal Business Name): BARBARA BOHLANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 CHICAGO STREET
JAVA SD
57452
US

IV. Provider business mailing address

13150 SITTING BULL RD
MOBRIDGE SD
57601-7501
US

V. Phone/Fax

Practice location:
  • Phone: 605-649-6296
  • Fax:
Mailing address:
  • Phone: 601-845-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number075-SLP
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: