Provider Demographics
NPI:1194936591
Name:BAUDIZZON, JAMIE LORN (THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:LORN
Last Name:BAUDIZZON
Suffix:
Gender:M
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 990073
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-0073
Mailing Address - Country:US
Mailing Address - Phone:530-241-9276
Mailing Address - Fax:530-241-0114
Practice Address - Street 1:1933 MARKET ST
Practice Address - Street 2:SUITE C
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1929
Practice Address - Country:US
Practice Address - Phone:530-241-9276
Practice Address - Fax:530-241-0114
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS172581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00767ZMedicare ID - Type Unspecified