Provider Demographics
NPI:1891416475
Name:BAUER, JENNI JO
Entity Type:Individual
Prefix:
First Name:JENNI
Middle Name:JO
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNI
Other - Middle Name:JO
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1810 VISTA RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-4801
Mailing Address - Country:US
Mailing Address - Phone:605-695-5287
Mailing Address - Fax:
Practice Address - Street 1:1810 VISTA RIDGE PL
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-4801
Practice Address - Country:US
Practice Address - Phone:605-695-5287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health