Healthcare Provider Details

I. General information

NPI: 1447477963
Provider Name (Legal Business Name): CINDY A BAHLS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY A RUDOLPH M.S.

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 ST. ANDREW STREET SUITE 100
LA CROSSE WI
54603-2378
US

IV. Provider business mailing address

2815 27TH ST S
LA CROSSE WI
54601-7653
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-6266
  • Fax:
Mailing address:
  • Phone: 608-788-2115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number9000-120
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: