Provider Demographics
NPI:1699814194
Name:BAUMGARTNER, ANDRIA RENEE (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:ANDRIA
Middle Name:RENEE
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:404 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9202
Mailing Address - Country:US
Mailing Address - Phone:630-551-0432
Mailing Address - Fax:630-527-3380
Practice Address - Street 1:404 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9202
Practice Address - Country:US
Practice Address - Phone:630-551-0432
Practice Address - Fax:630-527-3380
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006955235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist