Provider Demographics
NPI:1154027605
Name:BAUMGARTEL, JENNIFER LESLIE (CSW-INTERN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LESLIE
Last Name:BAUMGARTEL
Suffix:
Gender:F
Credentials:CSW-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 SANDESTIN DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2135
Mailing Address - Country:US
Mailing Address - Phone:775-800-1136
Mailing Address - Fax:
Practice Address - Street 1:2840 SANDESTIN DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-2135
Practice Address - Country:US
Practice Address - Phone:775-800-1136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV172V00000XMedicaid