Provider Demographics
NPI:1043508815
Name:BACH, DEWANN (BA)
Entity Type:Individual
Prefix:
First Name:DEWANN
Middle Name:
Last Name:BACH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 KELLEY PL FL 2
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-8654
Mailing Address - Country:US
Mailing Address - Phone:509-524-2920
Mailing Address - Fax:
Practice Address - Street 1:1520 KELLEY PL FL 2
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8654
Practice Address - Country:US
Practice Address - Phone:509-524-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical