Provider Demographics
NPI:1164161543
Name:BAHRKE, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:BAHRKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 OLD BARN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6241
Mailing Address - Country:US
Mailing Address - Phone:815-245-9234
Mailing Address - Fax:
Practice Address - Street 1:671 OLD BARN RD
Practice Address - Street 2:
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6241
Practice Address - Country:US
Practice Address - Phone:815-245-9234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health