Provider Demographics
NPI:1871647966
Name:BAELEN, SUSAN ELLEN (LM, CPM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELLEN
Last Name:BAELEN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HOFFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3129
Mailing Address - Country:US
Mailing Address - Phone:415-821-4213
Mailing Address - Fax:781-634-0723
Practice Address - Street 1:315 HOFFMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3129
Practice Address - Country:US
Practice Address - Phone:415-821-4213
Practice Address - Fax:781-634-0723
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0195176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife