Jara Bachtold – Licensed Practical Nurse

Key facts

NPI: 1770239675
Entity type: Individual (NPI type 1)
Primary specialty: Licensed Practical Nurse 164W00000X
License: 043.130912 (IL)
Practice address: 303 Landmark Dr Ste 2B
Normal, IL 61761-6164
Phone: (309) 808-2388
NPI assigned: Mar 1, 2022
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Bloomington-Normal Treatment Center, LLC Methadone Clinic · Normal, IL · NPI 1225389638

NPD

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
043.130912	IL	MD	Licensed Practical Nurse

Practice roles

Organization	Specialty	Status	New patients
Bloomington-Normal Treatment Center, LLC		Current since Feb 4, 2024	Accepting new patients

Locations

303 Landmark Dr
Ste 2B
Normal, IL 61761
Phone (309) 808-2388

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Licensed Practical Nurse	164W00000X	043.130912	IL	Yes

Addresses

Primary practice location

303 Landmark Dr Ste 2B
Normal, IL 61761-6164

Mailing address

303 Landmark Dr Ste 2B
Normal, IL 61761-6164
Phone (309) 808-2388

Electronic endpoints

Type	Endpoint	Use	Affiliation
Other URL	Normal

Other providers in Normal, IL

All providers in Normal, IL · Licensed Practical Nurse in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.