MEDICARE: JANICE BAUER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW00005169	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A002	OTHER	WA	ASURIS

General Provider Information

NPI Number	:	1134272263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE BAUER

Provider Business Mailing Address
First Line	:	46 POGUE RD
Second Line	:
City	:	OKANOGAN
State	:	WA
Zip	:	98840-8001
Country	:	US
Telephone Number	:	509-826-6191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 KOALA AVE
Second Line	:
City	:	OMAK
State	:	WA
Zip	:	98841-9247
Country	:	US
Telephone Number	:	509-826-6191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2007
Last Update Date	:	07/08/2007

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Directions to “ JANICE BAUER ” Practice Location

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