MEDICARE: KA-SIA MICHELLE BAUMER LCSW

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	LCSW-29998	ID

General Provider Information

NPI Number	:	1568647998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KA-SIA MICHELLE BAUMER LCSW

Provider Business Mailing Address
First Line	:	1459 MOUNTAIN VIEW LN
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-1813
Country	:	US
Telephone Number	:	606-880-5643
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 S WOODRUFF AVE STE B
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-6472
Country	:	US
Telephone Number	:	360-688-0564
Fax Number	:	208-529-2148

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

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	05/07/2024

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