Provider Demographics
NPI:1235323270
Name:KATHLEEN BAHLER & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:KATHLEEN BAHLER & ASSOCIATES, INC.
Other - Org Name:KATHLEEN BAHLER & ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW LCSW
Authorized Official - Phone:920-435-1188
Mailing Address - Street 1:315 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4522
Mailing Address - Country:US
Mailing Address - Phone:920-435-1188
Mailing Address - Fax:920-435-0276
Practice Address - Street 1:315 S JEFFERSON
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4522
Practice Address - Country:US
Practice Address - Phone:920-435-1188
Practice Address - Fax:920-435-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========012OtherBC/BS FACILITY PROV #
WI000044920Medicare PIN