Provider Demographics
NPI:1568647998
Name:BAUMER, KA-SIA MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:KA-SIA
Middle Name:MICHELLE
Last Name:BAUMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 MOUNTAIN VIEW LN
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-1813
Mailing Address - Country:US
Mailing Address - Phone:606-880-5643
Mailing Address - Fax:
Practice Address - Street 1:640 S WOODRUFF AVE STE B
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-5299
Practice Address - Country:US
Practice Address - Phone:360-688-0564
Practice Address - Fax:208-746-0811
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-299981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical