Doctor Name: | JENNA LAUREN BAUER |
NPI Number: | 1255524104 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | |
Business Practice Address: | 1928 Saint Marys Rd Moraga, CA - 945562715 |
Business Phone Number: | 9256314364 |
Business Fax Number: | |
Mailing Address: | Po Box 5217, MORAGA |
State: | CA |
Postal Code: | 945755217 |
Phone Number: | 9256314364 |
Fax Number: | |
NPI Enumeration Date: | 08/23/2007 |
NPI Last Update Date: | 10/28/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |