Provider Demographics
NPI:1225674476
Name:BAUER, LAURA REGINA (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:REGINA
Last Name:BAUER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:REGINA
Other - Last Name:AITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4115 LOUGHBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2807
Mailing Address - Country:US
Mailing Address - Phone:314-691-7498
Mailing Address - Fax:
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker