Provider Demographics
NPI:1063143261
Name:BAUMGARDNER, TERESA A (CMS)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:BAUMGARDNER
Suffix:
Gender:F
Credentials:CMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1186
Mailing Address - Country:US
Mailing Address - Phone:740-534-2100
Mailing Address - Fax:740-532-3385
Practice Address - Street 1:202 N 5TH ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1186
Practice Address - Country:US
Practice Address - Phone:740-534-2100
Practice Address - Fax:740-532-3385
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH181403101YA0400X
171M00000X
OHS.2308820104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0492504Medicaid