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General NPI Number Information
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NPI Number | 1457532343
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Entity Type | Organization
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Legal Business Name | CONSTANCE L. BAUER, LLC
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 180 N MICHIGAN AVE SUITE 605
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City | CHICAGO
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State | IL
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Zip | 60601-7401
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Country | US
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Telephone | 708-848-0491
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5888
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City | RIVER FOREST
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State | IL
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Zip | 60305-5888
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Country | US
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Telephone | 708-848-0491
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CONSTANCE LINN BAUER
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Credential | LCSW, JD
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Telephone | 708-848-0491
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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 | 149009945
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License Number State | IL
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