Provider Demographics
NPI:1144377268
Name:BAUER, ALAN JOHN (EDD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JOHN
Last Name:BAUER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 GRAND AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2764
Mailing Address - Country:US
Mailing Address - Phone:406-248-3558
Mailing Address - Fax:
Practice Address - Street 1:1925 GRAND AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2764
Practice Address - Country:US
Practice Address - Phone:406-248-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT67103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical