Provider Demographics
NPI:1932320843
Name:BAUER, MICHELE MOORE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:MOORE
Last Name:BAUER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:MOORE
Other - Last Name:BEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1044 NORTHWEST BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2114
Mailing Address - Country:US
Mailing Address - Phone:208-930-1740
Mailing Address - Fax:208-930-1695
Practice Address - Street 1:1044 NORTHWEST BLVD STE C
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2114
Practice Address - Country:US
Practice Address - Phone:208-930-1740
Practice Address - Fax:208-930-1695
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW283111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932320843OtherNPI