Provider Demographics
NPI:1407163108
Name:BAHN, SARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:BAHN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2421
Mailing Address - Country:US
Mailing Address - Phone:217-679-5379
Mailing Address - Fax:217-679-5349
Practice Address - Street 1:1220 S 7TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2421
Practice Address - Country:US
Practice Address - Phone:217-679-5379
Practice Address - Fax:217-679-5349
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3462103TC0700X
IL071008460103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407163108OtherNPI