Healthcare Provider Details

I. General information

NPI: 1841358900
Provider Name (Legal Business Name): SHEALYNNE ANNE BAUS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WALL ST
HURON OH
44839-1632
US

IV. Provider business mailing address

716 TRACHT MEADOWS DR
HURON OH
44839-1042
US

V. Phone/Fax

Practice location:
  • Phone: 419-602-3149
  • Fax:
Mailing address:
  • Phone: 419-602-3149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5908
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: