Provider Demographics
NPI:1457532343
Name:CONSTANCE L. BAUER, LLC
Entity Type:Organization
Organization Name:CONSTANCE L. BAUER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:LINN
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, JD
Authorized Official - Phone:708-848-0491
Mailing Address - Street 1:PO BOX 5888
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-5888
Mailing Address - Country:US
Mailing Address - Phone:708-848-0491
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7401
Practice Address - Country:US
Practice Address - Phone:708-848-0491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149009945251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216943OtherMEDICARE PTAN
IL216943Medicare PIN