Provider Demographics
NPI:1598165987
Name:BAUER MALANDRAKI, JAIME (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:BAUER MALANDRAKI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 CHESWICK CT APT 2
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-7451
Mailing Address - Country:US
Mailing Address - Phone:646-532-8221
Mailing Address - Fax:
Practice Address - Street 1:2600 GREENBUSH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2477
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005963A235Z00000X
NY021893-1235Z00000X
NJ41YS00695400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201317820Medicaid
IN000000960896OtherANTHEM PROVIDER NUMBER
IN815500109Medicare PIN
INP01629409Medicare PIN