Provider Demographics
NPI:1477848646
Name:WALDBAUER, JOY RENAE (LMSW)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:RENAE
Last Name:WALDBAUER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 S. OHIO ST.
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-2117
Mailing Address - Country:US
Mailing Address - Phone:785-825-6224
Mailing Address - Fax:785-827-7895
Practice Address - Street 1:306 N. CEDAR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-2623
Practice Address - Country:US
Practice Address - Phone:785-263-1328
Practice Address - Fax:785-263-4313
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3650101YA0400X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)