Individual
ILESA BAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2025 E MAIN ST STE 104, RICHMOND, VA 23223-7072
(804) 220-0564
Mailing address
2025 E MAIN ST STE 104, RICHMOND, VA 23223-7072
(804) 220-0564
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904020321
VA
Other
Enumeration date
05/13/2026
Last updated
05/13/2026
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