Organization
CONSTANCE L. BAUER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONSTANCE LINN BAUER LCSW, JD (MANAGING MEMBER)
(708) 848-0491
Entity
Organization
Contact information
Practice address
180 N MICHIGAN AVE, SUITE 605, CHICAGO, IL 60601-7401
(708) 848-0491
Mailing address
PO BOX 5888, RIVER FOREST, IL 60305-5888
(708) 848-0491
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
149009945
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
216943
MEDICARE PTAN
IL
Enumeration date
11/19/2007
Last updated
09/22/2008
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