Provider Demographics
NPI:1699833038
Name:BINGHAM, ANN BAILEY (EDUCATION SPECIALIST)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:BAILEY
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:EDUCATION SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 W 83RD ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208
Mailing Address - Country:US
Mailing Address - Phone:913-469-9680
Mailing Address - Fax:913-492-5803
Practice Address - Street 1:4121 W 83RD ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208
Practice Address - Country:US
Practice Address - Phone:913-469-9680
Practice Address - Fax:913-492-5803
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKANSAS109106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30157014OtherBCBS
MO30157014OtherBCBS