Healthcare Provider Details
I. General information
NPI: 1457950891
Provider Name (Legal Business Name): LAURA JEAN BAUS BS, RDH, MDH, PHDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 10/17/2020
Last Update Date: 10/17/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
519 E BODE RD
STREAMWOOD IL
60107-6897
US
IV. Provider business mailing address
519 E BODE RD
STREAMWOOD IL
60107-6897
US
V. Phone/Fax
- Phone: 224-279-5681
- Fax:
- Phone: 224-279-5681
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251E00000X |
| Taxonomy | Home Health Agency |
| License Number | 020.005374 |
| License Number State | IL |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251K00000X |
| Taxonomy | Public Health or Welfare Agency |
| License Number | 020.005374 |
| License Number State | IL |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QC1500X |
| Taxonomy | Community Health Clinic/Center |
| License Number | 020.005374 |
| License Number State | IL |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QD0000X |
| Taxonomy | Dental Clinic/Center |
| License Number | 020.005374 |
| License Number State | IL |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QF0400X |
| Taxonomy | Federally Qualified Health Center (FQHC) |
| License Number | 020.005374 |
| License Number State | IL |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QH0100X |
| Taxonomy | Health Service Clinic/Center |
| License Number | 020.005374 |
| License Number State | IL |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QP0904X |
| Taxonomy | Federal Public Health Clinic/Center |
| License Number | 020.005374 |
| License Number State | IL |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QP0905X |
| Taxonomy | State or Local Public Health Clinic/Center |
| License Number | 020.005374 |
| License Number State | IL |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 124Q00000X |
| Taxonomy | Dental Hygienist |
| License Number | DH16948 |
| License Number State | FL |
| # 10 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 124Q00000X |
| Taxonomy | Dental Hygienist |
| License Number | 020.005374 |
| License Number State | IL |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083P0901X |
| Taxonomy | Public Health & General Preventive Medicine Physician |
| License Number | 020.005374 |
| License Number State | IL |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 172V00000X |
| Taxonomy | Community Health Worker |
| License Number | 020.005374 |
| License Number State | IL |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 253Z00000X |
| Taxonomy | In Home Supportive Care Agency |
| License Number | 020.005374 |
| License Number State | IL |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171M00000X |
| Taxonomy | Case Manager/Care Coordinator |
| License Number | 020.005374 |
| License Number State | IL |
| # 15 | |
| Primary Taxonomy | N |
| Taxonomy Code | 174H00000X |
| Taxonomy | Health Educator |
| License Number | 020.005374 |
| License Number State | IL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
