Provider Demographics
NPI:1548641962
Name:BAUER, JEREMY M (LMSW)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:M
Last Name:BAUER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7840 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-2152
Mailing Address - Country:US
Mailing Address - Phone:913-328-4645
Mailing Address - Fax:913-328-4604
Practice Address - Street 1:7840 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2152
Practice Address - Country:US
Practice Address - Phone:913-328-4645
Practice Address - Fax:913-328-4604
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9593104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker