Provider Demographics
NPI:1619127107
Name:BAUMANN, KRISTIN ARLA (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ARLA
Last Name:BAUMANN
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 APPLETON RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-3727
Mailing Address - Country:US
Mailing Address - Phone:920-968-6225
Mailing Address - Fax:
Practice Address - Street 1:3130 N RANKIN ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1423
Practice Address - Country:US
Practice Address - Phone:920-205-7356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3130-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42594800Medicaid
WI3130-154OtherWISCONSIN SPEECH LANGUAGE PATHOLOGY LICENSE