Provider Demographics
NPI:1871748293
Name:KROHN BAILEY, JOANN M (MS)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:M
Last Name:KROHN BAILEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891-0036
Mailing Address - Country:US
Mailing Address - Phone:715-373-0160
Mailing Address - Fax:715-373-0162
Practice Address - Street 1:21 WEST OMAHA STREET
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:WI
Practice Address - Zip Code:54891-0036
Practice Address - Country:US
Practice Address - Phone:715-373-0160
Practice Address - Fax:715-373-0162
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI590-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional