MEDICARE: BAUER SPEECH THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1023991270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAUER SPEECH THERAPY, LLC

Provider Business Mailing Address
First Line	:	295 NW COMMONS LOOP # 115-256
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-7721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5421 SW COUNTY ROAD 240
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-1774
Country	:	US
Telephone Number	:	386-867-3706
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN BAUER
Credential	:	CCC-SLP
Telephone Number	:	386-867-3706

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	07/28/2025

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Directions to “BAUER SPEECH THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

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