Provider Demographics
NPI:1770682684
Name:BAUGHMAN, GLENN (LISW)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:BAUGHMAN
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1004
Mailing Address - Country:US
Mailing Address - Phone:515-243-5181
Mailing Address - Fax:515-243-2760
Practice Address - Street 1:1301 CENTER ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1004
Practice Address - Country:US
Practice Address - Phone:515-243-5181
Practice Address - Fax:515-243-2760
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical