Provider Demographics
NPI:1700374402
Name:BAUER, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CHURCHILL LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-3100
Mailing Address - Country:US
Mailing Address - Phone:309-532-4040
Mailing Address - Fax:224-520-8790
Practice Address - Street 1:125 FAIRFIELD WAY
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1597
Practice Address - Country:US
Practice Address - Phone:630-381-7426
Practice Address - Fax:224-520-8790
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL150.104874104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor