Provider Demographics
NPI:1730288648
Name:BAUGHMAN, IRIS RAE (PSYD)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:RAE
Last Name:BAUGHMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 REGENT CT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801
Mailing Address - Country:US
Mailing Address - Phone:814-237-0551
Mailing Address - Fax:814-237-0564
Practice Address - Street 1:110 REGENT CT
Practice Address - Street 2:SUITE 103
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-237-0551
Practice Address - Fax:814-237-0564
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS0057406103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50000769OtherCAPITAL BC
PA1381981OtherBS
PA50000769OtherCAPITAL BC