Provider Demographics
NPI:1407090897
Name:BAUER, BROCK ALLAN (LISW-S, SAP)
Entity Type:Individual
Prefix:
First Name:BROCK
Middle Name:ALLAN
Last Name:BAUER
Suffix:
Gender:M
Credentials:LISW-S, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 HARRISON AVE
Mailing Address - Street 2:304
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1346
Mailing Address - Country:US
Mailing Address - Phone:614-940-4868
Mailing Address - Fax:614-923-7525
Practice Address - Street 1:929 HARRISON AVE
Practice Address - Street 2:304
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1346
Practice Address - Country:US
Practice Address - Phone:614-940-4868
Practice Address - Fax:614-923-7525
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2013-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0700102-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical