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NPI Code Detail

MEDICARE: MIKYLAH BAUSCH MSW, LICSWA

MEDICARE: MIKYLAH BAUSCH MSW, LICSWA
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
11041C0700XClinical Social WorkerSC70076317WA
2101Y00000XCounselorCG61605780WA
3104100000XSocial WorkerSC70076317WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720809825
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKYLAH BAUSCH MSW, LICSWA
Provider Business Mailing Address
First Line : PO BOX 2394
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-8455
Country : US
Telephone Number : 360-200-5419
Fax Number : 360-200-6736
Provider Business Practice Location Address
First Line : 1400 COMMERCE AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-3756
Country : US
Telephone Number : 360-998-2047
Fax Number : 360-200-6736
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2024
Last Update Date : 03/02/2026

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