Provider Demographics
NPI:1942541446
Name:BAUER, JENNIFER A (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BAUER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:GUALANDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2833
Mailing Address - Country:US
Mailing Address - Phone:815-433-3953
Mailing Address - Fax:815-433-3980
Practice Address - Street 1:424 W MADISON ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2833
Practice Address - Country:US
Practice Address - Phone:815-433-3953
Practice Address - Fax:815-433-3980
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0156071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical