Provider Demographics
NPI:1841616596
Name:BAHR, MARY (SACIT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BAHR
Suffix:
Gender:F
Credentials:SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5923
Mailing Address - Country:US
Mailing Address - Phone:920-739-3235
Mailing Address - Fax:
Practice Address - Street 1:201 S GLENRIDGE CT
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3905
Practice Address - Country:US
Practice Address - Phone:920-731-3981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16972-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)