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General NPI Number Information
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NPI Number | 1063012136
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Entity Type | Organization
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Legal Business Name | MAUREEN BAUSCHKE LMSW
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 229 E MICHIGAN AVE STE 345
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City | KALAMAZOO
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State | MI
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Zip | 49007-6403
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Country | US
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Telephone | 269-350-4597
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50044
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City | KALAMAZOO
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State | MI
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Zip | 49005-0044
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Country | US
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Telephone | 269-350-4597
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAUREEN BAUSCKE
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Credential |
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Telephone | 269-350-4597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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