Individual
LYNETTE BAUER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CADC III
Contact information
Practice address
121 W MAIN ST, SUITE 350, PORT WASHINGTON, WI 53074-1813
(262) 284-8130
(262) 284-8104
Mailing address
PO BOX 994, PORT WASHINGTON, WI 53074-0994
(262) 284-8130
(262) 284-8104
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1699
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42138800
—
WI
Enumeration date
10/31/2005
Last updated
07/08/2007
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