Healthcare Provider Details

I. General information

NPI: 1225691330
Provider Name (Legal Business Name): DENISE ANN MCDUFFEY-BAUER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 CENTRAL AVE STE 300
FORT DODGE IA
50501-3954
US

IV. Provider business mailing address

2525 16TH AVE N
FORT DODGE IA
50501-7906
US

V. Phone/Fax

Practice location:
  • Phone: 806-570-4882
  • Fax:
Mailing address:
  • Phone: 806-570-4882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW18571
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110051
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: