Basic Information
| Provider Information | |||||||||
| NPI: | 1770644577 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUERLE | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MSW, LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3281 W BLUE SPRINGS LN | ||||||||
| Address2: | |||||||||
| City: | BLUFFDALE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840655649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3855155445 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1020 S MAIN ST STE 218 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841013176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889494864 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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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 | 104100000X | LW60058539 | WA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LW60058539 | WA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 9399264-3501 | UT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.