Provider Demographics
NPI:1063504025
Name:BAUM, LYNDA SUE (PHD, APRN)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:SUE
Last Name:BAUM
Suffix:
Gender:F
Credentials:PHD, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10938 N 5870 W
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9487
Mailing Address - Country:US
Mailing Address - Phone:801-756-8917
Mailing Address - Fax:
Practice Address - Street 1:881 W STATE RD STE 140-429
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2131
Practice Address - Country:US
Practice Address - Phone:801-422-9729
Practice Address - Fax:801-367-7678
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT180643-4405364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult