Provider Demographics
NPI:1235205899
Name:BAUER, CORRINE ARLENE (MA, LP)
Entity Type:Individual
Prefix:MS
First Name:CORRINE
Middle Name:ARLENE
Last Name:BAUER
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 SOUTH AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3311
Mailing Address - Country:US
Mailing Address - Phone:651-773-3513
Mailing Address - Fax:
Practice Address - Street 1:3570 LEXINGTON AVE N
Practice Address - Street 2:100
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8049
Practice Address - Country:US
Practice Address - Phone:651-481-0664
Practice Address - Fax:651-481-3907
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1462103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10D21BAOtherBCBS
MNHP18513OtherHEALTHPARTNERS