Provider Demographics
NPI:1720424559
Name:BAUSS, KATHRYN JEAN (MED AND MA TLLP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:JEAN
Last Name:BAUSS
Suffix:
Gender:F
Credentials:MED AND MA TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 WALTON BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6917
Mailing Address - Country:US
Mailing Address - Phone:248-656-8500
Mailing Address - Fax:
Practice Address - Street 1:1202 WALTON BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6917
Practice Address - Country:US
Practice Address - Phone:248-656-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015392103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical