Provider Demographics
NPI:1538353867
Name:BAUER, CONSTANCE LINN (JD, LCSW, LLC)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:LINN
Last Name:BAUER
Suffix:
Gender:F
Credentials:JD, LCSW, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1515
Mailing Address - Country:US
Mailing Address - Phone:708-848-8656
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:708-848-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical