Provider Demographics
NPI:1750909628
Name:VAHL, BRIAN FRANK
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:FRANK
Last Name:VAHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N BASIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62837-9639
Mailing Address - Country:US
Mailing Address - Phone:618-516-5326
Mailing Address - Fax:
Practice Address - Street 1:407 N BASIN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IL
Practice Address - Zip Code:62837-9639
Practice Address - Country:US
Practice Address - Phone:618-516-5326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)