Provider Demographics
NPI:1558548511
Name:BAUM, ANITA MARIE (CCC/A)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:BAUM
Suffix:
Gender:F
Credentials:CCC/A
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:MARIE
Other - Last Name:MAJERUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 BANDANA BLVD E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5113
Mailing Address - Country:US
Mailing Address - Phone:651-642-2700
Mailing Address - Fax:651-642-9441
Practice Address - Street 1:1020 BANDANA BLVD W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5107
Practice Address - Country:US
Practice Address - Phone:651-641-7000
Practice Address - Fax:651-641-7166
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5246231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist