Provider Demographics
NPI:1942301890
Name:BAUER, NATALIE R (LCSW)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:R
Last Name:BAUER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9111 BROADWAY
Mailing Address - Street 2:SUITE N
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8122
Mailing Address - Country:US
Mailing Address - Phone:219-793-1233
Mailing Address - Fax:219-793-1244
Practice Address - Street 1:9111 BROADWAY
Practice Address - Street 2:SUITE N
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8122
Practice Address - Country:US
Practice Address - Phone:219-793-1233
Practice Address - Fax:219-793-1244
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340048951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000362029OtherANTHEM PROVIDER NUMBER
IN785384000OtherMAGELLAN PROVIDER NUMBER
230520Medicare ID - Type Unspecified