Provider Demographics
NPI:1326802240
Name:BAUMGARTNER, JULIE (IBCLC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5090 W 143RD ST
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2737
Mailing Address - Country:US
Mailing Address - Phone:727-992-3843
Mailing Address - Fax:
Practice Address - Street 1:8901 AZTEC DR STE B
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1916
Practice Address - Country:US
Practice Address - Phone:678-509-6455
Practice Address - Fax:651-666-1295
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-314544174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN