Provider Demographics
NPI:1972682516
Name:BAUER, DEBORAH SCHLUTER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:SCHLUTER
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 1:214 MOUNTAIN AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4118
Mailing Address - Country:US
Mailing Address - Phone:540-343-5455
Mailing Address - Fax:540-343-5074
Practice Address - Street 1:214 MOUNTAIN AVE SW
Practice Address - Street 2:INTERFAITH COUNSELING SERVICES
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4118
Practice Address - Country:US
Practice Address - Phone:540-343-5455
Practice Address - Fax:540-343-5074
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040070651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40932700Medicaid
WI40932700Medicaid