Provider Demographics
NPI:1780746800
Name:BAUER, SUSANNE JO
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:JO
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 LITTLE FLOCK RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-5878
Mailing Address - Country:US
Mailing Address - Phone:812-876-5202
Mailing Address - Fax:
Practice Address - Street 1:5155 LITTLE FLOCK RD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-5878
Practice Address - Country:US
Practice Address - Phone:812-876-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities