Provider Demographics
NPI:1689047219
Name:BAUER, MARTINA GABRIELLA PRETI
Entity Type:Individual
Prefix:MRS
First Name:MARTINA
Middle Name:GABRIELLA PRETI
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARTINA
Other - Middle Name:GABRIELLA
Other - Last Name:PRETI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 BANBURY PL SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3991
Mailing Address - Country:US
Mailing Address - Phone:206-552-9674
Mailing Address - Fax:
Practice Address - Street 1:3600 BANBURY PL SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-3991
Practice Address - Country:US
Practice Address - Phone:206-552-9674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALH60959796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health