Provider Demographics
NPI:1194209072
Name:BAHNAN, JWAN
Entity Type:Individual
Prefix:
First Name:JWAN
Middle Name:
Last Name:BAHNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 MATTS DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8435
Mailing Address - Country:US
Mailing Address - Phone:602-881-9655
Mailing Address - Fax:
Practice Address - Street 1:1347 HAUSMAN RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9063
Practice Address - Country:US
Practice Address - Phone:610-573-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist