Provider Demographics
NPI:1841358900
Name:BAUS, SHEALYNNE ANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHEALYNNE
Middle Name:ANNE
Last Name:BAUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 TRACHT MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1042
Mailing Address - Country:US
Mailing Address - Phone:419-602-3149
Mailing Address - Fax:
Practice Address - Street 1:105 WALL ST
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-1632
Practice Address - Country:US
Practice Address - Phone:419-602-3149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5908103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP74899Medicare UPIN
OHBACP28641Medicare PIN