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General NPI Number Information
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NPI Number | 1114096393
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Entity Type | Individual
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Provider Name | RENEE CAROLYN BAUER-WOLF LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 04/30/2020
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Provider Practice Location Address
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Address Line | 3901 FOX RUN RD.
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City | LOHMAN
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State | MO
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Zip | 65053
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Country | US
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Telephone | 410-596-4920
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Fax |
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Provider Business Mailing Address
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Address Line | 3109 FOX RUN RD
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City | LOHMAN
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State | MO
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Zip | 65053-9831
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Country | US
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Telephone | 412-087-6303
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 06884
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License Number State | MD
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