Provider Demographics
NPI:1992272892
Name:BARDWELL, KAREN RANEE (MSW, QMHP)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:RANEE
Last Name:BARDWELL
Suffix:
Gender:
Credentials:MSW, QMHP
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 962
Mailing Address - Street 2:
Mailing Address - City:POTTSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75076-0962
Mailing Address - Country:US
Mailing Address - Phone:903-771-8731
Mailing Address - Fax:
Practice Address - Street 1:108 S MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:POTTSBORO
Practice Address - State:TX
Practice Address - Zip Code:75076-3058
Practice Address - Country:US
Practice Address - Phone:903-771-8731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
TX686921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker