Provider Demographics
NPI:1659577625
Name:BAUER, TRACIE R (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:R
Last Name:BAUER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:TRACIE
Other - Middle Name:R
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4015 SW MOUNDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66610-2334
Mailing Address - Country:US
Mailing Address - Phone:785-249-9626
Mailing Address - Fax:
Practice Address - Street 1:327 SW FRAZIER AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1963
Practice Address - Country:US
Practice Address - Phone:785-232-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS67771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical