Provider Demographics
NPI:1962181644
Name:BAUMBERGER, JASON LEE (CLS, ASCP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LEE
Last Name:BAUMBERGER
Suffix:
Gender:M
Credentials:CLS, ASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 NEWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-3216
Mailing Address - Country:US
Mailing Address - Phone:612-518-0577
Mailing Address - Fax:
Practice Address - Street 1:740 NEWBERRY LN
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-3216
Practice Address - Country:US
Practice Address - Phone:612-518-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD210142246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist