Provider Demographics
NPI:1275966400
Name:BAUDER, RONALD DELOS JR (LCSW)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DELOS
Last Name:BAUDER
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:GOOD SAMARITAN BOYS RANCH
Mailing Address - City:BRIGHTON
Mailing Address - State:MO
Mailing Address - Zip Code:65617
Mailing Address - Country:US
Mailing Address - Phone:417-376-2238
Mailing Address - Fax:417-376-2014
Practice Address - Street 1:5549 HIGHWAY K OLD HIGHWAY 13
Practice Address - Street 2:GOOD SAMARITAN BOYS RANCH
Practice Address - City:BRIGHTON
Practice Address - State:MO
Practice Address - Zip Code:65617
Practice Address - Country:US
Practice Address - Phone:417-376-2238
Practice Address - Fax:417-376-2014
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120001241041C0700X
MO20140152301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical