Provider Demographics
NPI:1861633349
Name:BAUER, STEFANIE
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
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 1:658 GRAND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3492
Mailing Address - Country:US
Mailing Address - Phone:612-454-1656
Mailing Address - Fax:651-560-3768
Practice Address - Street 1:790 CLEVELAND AVE S STE 217
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3845
Practice Address - Country:US
Practice Address - Phone:612-454-1656
Practice Address - Fax:651-560-3768
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical