Provider Demographics
NPI:1386191534
Name:BAUMGARTNER, SALLY (MA)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 CATALPA PL
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-7553
Mailing Address - Country:US
Mailing Address - Phone:206-962-1463
Mailing Address - Fax:
Practice Address - Street 1:1203 CATALPA PL
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-7553
Practice Address - Country:US
Practice Address - Phone:206-962-1463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0014818101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health