Provider Demographics
NPI:1770654824
Name:BAUER, MELINDA GRADY (MSW, LISW)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:GRADY
Last Name:BAUER
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10597 MONTGOMERY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4471
Mailing Address - Country:US
Mailing Address - Phone:513-793-6226
Mailing Address - Fax:513-793-5054
Practice Address - Street 1:10597 MONTGOMERY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4471
Practice Address - Country:US
Practice Address - Phone:513-793-6226
Practice Address - Fax:513-793-5054
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00070821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBASW29901Medicare ID - Type Unspecified