Provider Demographics
NPI:1710363213
Name:BACH, PATTI (MSW)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:BACH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 COACH WAGONER BLVD
Mailing Address - Street 2:
Mailing Address - City:APALACHICOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32320-2150
Mailing Address - Country:US
Mailing Address - Phone:717-350-8855
Mailing Address - Fax:
Practice Address - Street 1:192 COACH WAGONER BLVD
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32320-2150
Practice Address - Country:US
Practice Address - Phone:717-350-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132695104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker