Provider Demographics
NPI:1629524269
Name:BAUMGARTNER, PAM
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1338
Mailing Address - Street 2:320 NORTH EISENHOWER AVENUE
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402
Mailing Address - Country:US
Mailing Address - Phone:641-424-2391
Mailing Address - Fax:641-424-0786
Practice Address - Street 1:320 NORTH EISENHOWER AVENUE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50402
Practice Address - Country:US
Practice Address - Phone:641-424-2391
Practice Address - Fax:641-424-0786
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)