Mary Bauer, MA, LADC, MFT INTERN
Individual provider Active NPI Psychoanalyst · Jordan, MN
NPI 1033529664 · NPPES record last updated Jan 22, 2020
Key facts
- NPI
- 1033529664
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychoanalyst 102L00000X
- Practice address
- 110 1St St E Ste 102
Jordan, MN 55352-1502 - Phone
- (651) 356-5234
- NPI assigned
- May 5, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychoanalyst | 102L00000X | Yes |
Addresses
Primary practice location
110 1St St E Ste 102
Jordan, MN 55352-1502
Mailing address
7997 147TH St W
Apple Valley, MN 55124-6347
Phone (651) 356-5234
Other practice location 1
10505 Wayzata Blvd Ste 110
Minnetonka, MN 55305-1502
Phone (651) 356-5234
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033529664 | Other | MN | MENTAL HEALTH AND SUBSTANC E ABUSE |
| 1033529664 | Medicaid | MN |
Other providers in Jordan, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.