Healthcare Provider Details

I. General information

NPI: 1801954102
Provider Name (Legal Business Name): MIKE T. BAUER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W CAPITOL DR
MILWAUKEE WI
53212-1123
US

IV. Provider business mailing address

N88 W17966 CHRISTMAN ROAD
MENOMONEE FALLS WI
53051
US

V. Phone/Fax

Practice location:
  • Phone: 414-727-6320
  • Fax: 414-727-6321
Mailing address:
  • Phone: 262-853-7716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1817-132
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1602-123
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number153-124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: