Individual
DIANE ELIZABETH BAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
4505 WHITE BEAR PKWY, SUITE 1800, WHITE BEAR LAKE, MN 55110-3678
(651) 426-8191
(651) 426-6766
Mailing address
1213 SILVERWOOD RD, WOODBURY, MN 55125-8684
(651) 731-1196
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2107
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4G022DA
BLUE CROSS/BLUE SHIELD
MN
01
—
62-74660
UBH
MN
Enumeration date
10/18/2006
Last updated
07/08/2007
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