Provider Demographics
NPI:1558197509
Name:BAUSMAN, MCKENNA MARIE
Entity type:Individual
Prefix:MISS
First Name:MCKENNA
Middle Name:MARIE
Last Name:BAUSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4673 WASHTENAW AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1301
Mailing Address - Country:US
Mailing Address - Phone:734-547-5009
Mailing Address - Fax:734-215-1231
Practice Address - Street 1:4673 WASHTENAW AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1301
Practice Address - Country:US
Practice Address - Phone:734-547-5009
Practice Address - Fax:734-215-1231
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)