Provider Demographics
NPI:1114096393
Name:BAUER-WOLF, RENEE CAROLYN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:CAROLYN
Last Name:BAUER-WOLF
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 FOX RUN RD
Mailing Address - Street 2:
Mailing Address - City:LOHMAN
Mailing Address - State:MO
Mailing Address - Zip Code:65053-9831
Mailing Address - Country:US
Mailing Address - Phone:412-087-6303
Mailing Address - Fax:
Practice Address - Street 1:3901 FOX RUN RD.
Practice Address - Street 2:
Practice Address - City:LOHMAN
Practice Address - State:MO
Practice Address - Zip Code:65053
Practice Address - Country:US
Practice Address - Phone:410-596-4920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD068841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical