Provider Demographics
NPI:1215302609
Name:BAUER, JOE (LMSW)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:BAUER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:ID
Mailing Address - Zip Code:83867-0119
Mailing Address - Country:US
Mailing Address - Phone:208-752-1019
Mailing Address - Fax:208-752-1063
Practice Address - Street 1:104 WIND RIVER RD
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:ID
Practice Address - Zip Code:83867-0119
Practice Address - Country:US
Practice Address - Phone:208-752-1019
Practice Address - Fax:208-752-1063
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLSW-28236104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker