Provider Demographics
NPI:1740658467
Name:BAHR, CASEY JANE
Entity type:Individual
Prefix:MS
First Name:CASEY
Middle Name:JANE
Last Name:BAHR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CASEY BAHR, TRU- SOTAP
Mailing Address - Street 2:16550 177TH AVE SE
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272
Mailing Address - Country:US
Mailing Address - Phone:360-794-2440
Mailing Address - Fax:
Practice Address - Street 1:CASEY BAHR, C.O. TRU- SOTAP
Practice Address - Street 2:16550 177TH AVE SE
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272
Practice Address - Country:US
Practice Address - Phone:360-794-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
WA607920801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical