Provider Demographics
NPI:1073233003
Name:BAUMAN, ALEXANDER GEORGE (MSW, CADC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GEORGE
Last Name:BAUMAN
Suffix:
Gender:M
Credentials:MSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3210
Mailing Address - Country:US
Mailing Address - Phone:312-330-2561
Mailing Address - Fax:
Practice Address - Street 1:3000 DUNDEE RD STE 418
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2436
Practice Address - Country:US
Practice Address - Phone:847-306-6477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL39359101YA0400X
IL8868069621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)