Provider Demographics
NPI:1033529664
Name:BAUER, MARY (MA, LADC, MFT INTERN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:MA, LADC, MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7997 147TH ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6347
Mailing Address - Country:US
Mailing Address - Phone:651-356-5234
Mailing Address - Fax:
Practice Address - Street 1:110 1ST ST E STE 102
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-1502
Practice Address - Country:US
Practice Address - Phone:651-356-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1033529664OtherMENTAL HEALTH AND SUBSTANC E ABUSE
MN1033529664Medicaid