Provider Demographics
NPI:1467599431
Name:BAHLER, KATHLEEN J (MSSW ACSW LSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:J
Last Name:BAHLER
Suffix:
Gender:F
Credentials:MSSW ACSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 SOUTH JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2412
Mailing Address - Country:US
Mailing Address - Phone:920-435-1188
Mailing Address - Fax:920-432-0772
Practice Address - Street 1:603 BEAUPRE ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2412
Practice Address - Country:US
Practice Address - Phone:920-435-1188
Practice Address - Fax:920-435-0276
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9921231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000144920Medicare PIN