Provider Demographics
NPI:1083717433
Name:BAUER, JOSEPH JAMES (MSE, LP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JAMES
Last Name:BAUER
Suffix:
Gender:M
Credentials:MSE, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11010 PAWNEE AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-9592
Mailing Address - Country:US
Mailing Address - Phone:612-817-5487
Mailing Address - Fax:651-439-8350
Practice Address - Street 1:1068 S. LAKE ST. #109
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025
Practice Address - Country:US
Practice Address - Phone:612-817-5487
Practice Address - Fax:651-439-8350
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0332103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist