Provider Demographics
NPI:1396268934
Name:BAUGHMAN, NICOLE (LISW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BAUGHMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:LAMAYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2780 AIRPORT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2289
Mailing Address - Country:US
Mailing Address - Phone:614-859-1906
Mailing Address - Fax:614-645-5517
Practice Address - Street 1:1905 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1933
Practice Address - Country:US
Practice Address - Phone:614-253-8050
Practice Address - Fax:614-645-5517
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1701112104100000X
OHI.22041061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0285020Medicaid