Individual
MIKYLAH BAUSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LICSWA
Contact information
Practice address
1400 COMMERCE AVE, LONGVIEW, WA 98632-3756
(360) 998-2047
(360) 200-6736
Mailing address
PO BOX 2394, LONGVIEW, WA 98632-8455
(360) 200-5419
(360) 200-6736
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CG61605780
WA
104100000X
Social Worker
Primary
SC70076317
WA
1041C0700X
Clinical Social Worker
SC70076317
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2303956
—
WA
Enumeration date
10/21/2024
Last updated
03/02/2026
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