Provider Demographics
NPI:1003428566
Name:BAUMGART, LAURA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:BAUMGART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 E EMIGRATION CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1672
Mailing Address - Country:US
Mailing Address - Phone:734-306-1279
Mailing Address - Fax:
Practice Address - Street 1:1390 S 1100 E STE 204
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2463
Practice Address - Country:US
Practice Address - Phone:734-306-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9539712-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical