Provider Demographics
NPI:1316996085
Name:BAYER, KEITH RUSSELL (LCSW)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:RUSSELL
Last Name:BAYER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 OLD ORCHARD RD STE 46
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1027
Mailing Address - Country:US
Mailing Address - Phone:847-231-3729
Mailing Address - Fax:847-581-1895
Practice Address - Street 1:5225 OLD ORCHARD RD
Practice Address - Street 2:SUITE 34
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4405
Practice Address - Country:US
Practice Address - Phone:847-231-3729
Practice Address - Fax:847-581-1895
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490116331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635849OtherBCBS-IL PROVIDER NUMBER