Provider Demographics
NPI:1316359268
Name:BAYLEY-NEURAUTER, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BAYLEY-NEURAUTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 4TH ST NW
Mailing Address - Street 2:ROOM 103
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-2947
Mailing Address - Country:US
Mailing Address - Phone:701-845-8521
Mailing Address - Fax:701-845-4281
Practice Address - Street 1:230 4TH ST NW
Practice Address - Street 2:ROOM 103
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-2947
Practice Address - Country:US
Practice Address - Phone:701-845-8521
Practice Address - Fax:701-845-4281
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3986104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker