Provider Demographics
NPI:1013180454
Name:BAER, KIMBERLY KAY (LCSW, MSW, MHS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:BAER
Suffix:
Gender:F
Credentials:LCSW, MSW, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 W 950 S
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IN
Mailing Address - Zip Code:46740-9632
Mailing Address - Country:US
Mailing Address - Phone:260-525-0185
Mailing Address - Fax:
Practice Address - Street 1:5605 W 950 S
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IN
Practice Address - Zip Code:46740-9632
Practice Address - Country:US
Practice Address - Phone:260-525-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN310000819A225X00000X
IN34007336A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34007336AOtherLICENSED CLINICAL SOCIAL WORKER