Provider Demographics
NPI:1447477963
Name:BAHLS, CINDY A (MS)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:A
Last Name:BAHLS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:A
Other - Last Name:RUDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2815 27TH ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7653
Mailing Address - Country:US
Mailing Address - Phone:608-788-2115
Mailing Address - Fax:
Practice Address - Street 1:1407 ST. ANDREW STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-2378
Practice Address - Country:US
Practice Address - Phone:608-785-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9000-120171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator