Provider Demographics
NPI:1639399934
Name:BAUMGARTNER, DAWN M
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:KOSNOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3160
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85217-3160
Mailing Address - Country:US
Mailing Address - Phone:480-288-5328
Mailing Address - Fax:480-288-5339
Practice Address - Street 1:564 N IDAHO RD
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85219-4002
Practice Address - Country:US
Practice Address - Phone:520-689-2457
Practice Address - Fax:520-689-2745
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ122521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical