Healthcare Provider Details

I. General information

NPI: 1316857006
Provider Name (Legal Business Name): CHARLES E BAUERNFEIND CAPSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 W LOCUST ST
MILWAUKEE WI
53210-1626
US

IV. Provider business mailing address

2846 N 74TH ST
MILWAUKEE WI
53210-1010
US

V. Phone/Fax

Practice location:
  • Phone: 414-874-5861
  • Fax:
Mailing address:
  • Phone: 414-874-5861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number942-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: