Provider Demographics
NPI:1417473174
Name:BAUMER, JANE POTTER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:POTTER
Last Name:BAUMER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2148
Mailing Address - Country:US
Mailing Address - Phone:724-910-1215
Mailing Address - Fax:
Practice Address - Street 1:3556 S 5600 W # 1-769
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2815
Practice Address - Country:US
Practice Address - Phone:332-244-1539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14053064OtherCERTIFICATE OF CLINICAL COMPETENCE, AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
PASL013526OtherCOMMONWEALTH OF PA, BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS