Provider Demographics
NPI:1245981067
Name:BACHELIER, JACOB (MSW)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:BACHELIER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10777 BARKLEY ST STE 120
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1162
Mailing Address - Country:US
Mailing Address - Phone:913-204-0582
Mailing Address - Fax:
Practice Address - Street 1:10777 BARKLEY ST STE 120
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1162
Practice Address - Country:US
Practice Address - Phone:913-204-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12451-T1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS12451-TOtherSTATE LIC,