Basic Information
| Provider Information | |||||||||
| NPI: | 1972682516 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUER | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | SCHLUTER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 MOUNTAIN AVE SW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240164118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403435455 | ||||||||
| FaxNumber: | 5403435074 | ||||||||
| Practice Location | |||||||||
| Address1: | 214 MOUNTAIN AVE SW | ||||||||
| Address2: | INTERFAITH COUNSELING SERVICES | ||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240164118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403435455 | ||||||||
| FaxNumber: | 5403435074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 07/01/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904007065 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 40932700 | 05 | WI | MEDICAID |