Provider Demographics
NPI:1144269325
Name:BAHNER, CAMMY L (MS-CCC-A)
Entity type:Individual
Prefix:
First Name:CAMMY
Middle Name:L
Last Name:BAHNER
Suffix:
Gender:F
Credentials:MS-CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 HIGHWAY 59 S
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-4331
Mailing Address - Country:US
Mailing Address - Phone:218-671-4747
Mailing Address - Fax:218-683-2595
Practice Address - Street 1:1720 HIGHWAY 59 S
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-4331
Practice Address - Country:US
Practice Address - Phone:218-671-4747
Practice Address - Fax:218-683-2595
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7095231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP42009OtherHEALTHPARTNERS #
MN4500539OtherMEDICA #
MN2130679OtherAMERICA'S PPO/ARAZ #
MN34901OtherLHS/BANNERHEALTH #
MN54831Medicaid
MN26391OtherNDBS #
MN24577OtherNDBS #
FM4500415OtherMEDICA #
MN829S3BAOtherMNBS #
MN023H1BAOtherMNBS #
MN4500539OtherMEDICA #