Provider Demographics
NPI:1801660196
Name:BOHN, AILEEN B
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:B
Last Name:BOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:B
Other - Last Name:BOHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MC
Mailing Address - Street 1:554 N FRASER DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-7219
Mailing Address - Country:US
Mailing Address - Phone:480-734-1448
Mailing Address - Fax:
Practice Address - Street 1:32 S MACDONALD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-1310
Practice Address - Country:US
Practice Address - Phone:480-734-1448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health