Provider Demographics
NPI:1285179093
Name:BAUSCH, KERI A (LMSW)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:A
Last Name:BAUSCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:A
Other - Last Name:TANKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:626 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-1462
Mailing Address - Country:US
Mailing Address - Phone:785-362-7000
Mailing Address - Fax:
Practice Address - Street 1:626 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-1462
Practice Address - Country:US
Practice Address - Phone:785-362-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 172V00000X
KS11306104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker