Provider Demographics
NPI:1194967356
Name:CATHY AHLRICH
Entity type:Organization
Organization Name:CATHY AHLRICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:INDIGO
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-872-1003
Mailing Address - Street 1:345 E ASH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6138
Mailing Address - Country:US
Mailing Address - Phone:217-872-1003
Mailing Address - Fax:217-233-4150
Practice Address - Street 1:345 E ASH AVE STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6138
Practice Address - Country:US
Practice Address - Phone:217-872-1003
Practice Address - Fax:217-233-4150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1649349739Medicare PIN