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General NPI Number Information
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NPI Number | 1023969888
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Entity Type | Individual
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Provider Name | MIKAYLA BAVARO LSW
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Gender | Female
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Dates
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Enumeration Date | 02/06/2026
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 377 W VIRGINIA ST
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-5756
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Country | US
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Telephone | 815-707-4806
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 HASSELL RD APT 214
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-6326
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Country | US
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Telephone | 847-340-8111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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