Provider Demographics
NPI:1861590119
Name:BAUER, WAYNE F (MSW)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:F
Last Name:BAUER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 HIGGINS RD
Mailing Address - Street 2:STE 150
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195
Mailing Address - Country:US
Mailing Address - Phone:847-836-8028
Mailing Address - Fax:847-836-8028
Practice Address - Street 1:2200 HIGGINS RD
Practice Address - Street 2:STE 150
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60195
Practice Address - Country:US
Practice Address - Phone:847-836-8028
Practice Address - Fax:847-836-8028
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
201655Medicare ID - Type Unspecified