Provider Demographics
NPI:1164819058
Name:BAUER, CARINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARINA
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 N HICKORY ST
Mailing Address - Street 2:UNIT 102
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3687
Mailing Address - Country:US
Mailing Address - Phone:773-322-2385
Mailing Address - Fax:
Practice Address - Street 1:100 N CHESTNUT ST
Practice Address - Street 2:SUITE 244
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4856
Practice Address - Country:US
Practice Address - Phone:217-621-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-19
Last Update Date:2015-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008874103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical