Provider Demographics
NPI:1568793198
Name:BAHR, RHONDA GRACE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:GRACE
Last Name:BAHR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 WESTWOOD AVE APT 19
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-6803
Mailing Address - Country:US
Mailing Address - Phone:509-629-9111
Mailing Address - Fax:
Practice Address - Street 1:113 2ND ST STE 7
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2245
Practice Address - Country:US
Practice Address - Phone:509-629-9111
Practice Address - Fax:509-629-9111
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW607283151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1568793198Medicaid