Provider Demographics
NPI:1255915401
Name:BAUER, MEGAN R (SAC-IT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:R
Last Name:BAUER
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7643 RAPPY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-7831
Mailing Address - Country:US
Mailing Address - Phone:715-571-9401
Mailing Address - Fax:
Practice Address - Street 1:N4851 HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-8675
Practice Address - Country:US
Practice Address - Phone:715-635-4858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19440-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)