Provider Demographics
NPI:1902352693
Name:BAUMGARTEL, MARY (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BAUMGARTEL
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10124 THE STRAND
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-1233
Mailing Address - Country:US
Mailing Address - Phone:203-556-7387
Mailing Address - Fax:
Practice Address - Street 1:10124 THE STRAND
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-1233
Practice Address - Country:US
Practice Address - Phone:203-556-7387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005023235Z00000X
CASP 24243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist