Healthcare Provider Details

I. General information

NPI: 1568250439
Provider Name (Legal Business Name): AMY A BAYER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FOREST AVE STE 16
FOND DU LAC WI
54935-4165
US

IV. Provider business mailing address

17 FOREST AVE STE 16
FOND DU LAC WI
54935-4165
US

V. Phone/Fax

Practice location:
  • Phone: 920-322-5602
  • Fax:
Mailing address:
  • Phone: 920-322-5602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12835-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: