Provider Demographics
NPI:1720227358
Name:BAUER CHILD DEVELOPMENT SERVICES, LLC
Entity Type:Organization
Organization Name:BAUER CHILD DEVELOPMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:386-867-3706
Mailing Address - Street 1:295 NW COMMONS LOOP
Mailing Address - Street 2:SUITE 115-256
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-7709
Mailing Address - Country:US
Mailing Address - Phone:386-867-3706
Mailing Address - Fax:386-752-4462
Practice Address - Street 1:225 SW STAFFORD CT
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-1144
Practice Address - Country:US
Practice Address - Phone:386-867-3706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6822251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS2727OtherBLUECROSS/BLUESHIELD OF FLORIDA