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General NPI Number Information
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NPI Number | 1548507817
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Entity Type | Organization
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Legal Business Name | BAHN AND ASSOCIATES
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 3000 PROFESSIONAL DR STE D BAHN CONSULTING, INC.
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City | SPRINGFIELD
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State | IL
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Zip | 62703-5931
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Country | US
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Telephone | 217-679-5379
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Fax | 217-679-5349
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Provider Business Mailing Address
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Address Line | 3000 PROFESSIONAL DR STE D
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City | SPRINGFIELD
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State | IL
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Zip | 62703-5931
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Country | US
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Telephone | 217-679-5379
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Fax | 217-679-5349
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. SARA BAHN
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Credential | PSYD
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Telephone | 217-679-5379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008460
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License Number State | IL
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