Provider Demographics
NPI:1013508522
Name:BAUER, GREGORY ARLOIS (SUDP, NCAC1)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ARLOIS
Last Name:BAUER
Suffix:
Gender:M
Credentials:SUDP, NCAC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16404 SMOKEY POINT BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8417
Mailing Address - Country:US
Mailing Address - Phone:360-658-1388
Mailing Address - Fax:360-658-9842
Practice Address - Street 1:16404 SMOKEY POINT BLVD STE 109
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8417
Practice Address - Country:US
Practice Address - Phone:360-658-1388
Practice Address - Fax:360-658-9842
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00003065101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)