Provider Demographics
NPI:1205012200
Name:BAUER, MARIE SUZANNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:SUZANNE
Last Name:BAUER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 E WEST MAPLE RD
Mailing Address - Street 2:SUITE B204
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3816
Mailing Address - Country:US
Mailing Address - Phone:248-926-0909
Mailing Address - Fax:248-624-3332
Practice Address - Street 1:2075 E WEST MAPLE RD
Practice Address - Street 2:SUITE B204
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3816
Practice Address - Country:US
Practice Address - Phone:248-926-0909
Practice Address - Fax:248-624-3332
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12065457235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist