MEDICARE: EILEEN BAUER LLC

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

General Provider Information

NPI Number	:	1376249532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EILEEN BAUER LLC

Provider Business Mailing Address
First Line	:	350 S COLUMBUS BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-4138
Country	:	US
Telephone Number	:	520-977-1364
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 S COLUMBUS BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-4138
Country	:	US
Telephone Number	:	520-977-1364
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EILEEN BAUER
Credential	:
Telephone Number	:	520-977-1364

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	01/31/2023

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