Provider Demographics
NPI:1114125119
Name:BAUMAN, LORI A (LCSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 CROWN CIR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4166
Mailing Address - Country:US
Mailing Address - Phone:573-535-8315
Mailing Address - Fax:314-200-2167
Practice Address - Street 1:18384 NAEGER LN
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-9116
Practice Address - Country:US
Practice Address - Phone:573-535-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MO2017004899103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO730048655Medicaid