Provider Demographics
NPI:1104065887
Name:BAUER-JONES, MARY ANN (MSW, CDP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:BAUER-JONES
Suffix:
Gender:F
Credentials:MSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E. COLLEGE WAY #A, PMB 486
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273
Mailing Address - Country:US
Mailing Address - Phone:360-982-2715
Mailing Address - Fax:360-982-2716
Practice Address - Street 1:1310 E COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5619
Practice Address - Country:US
Practice Address - Phone:360-982-2715
Practice Address - Fax:360-982-2716
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00000549101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)