Provider Demographics
NPI:1790993285
Name:BAUDER, YVONNE G (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:G
Last Name:BAUDER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 WALNUT SHADE
Mailing Address - Street 2:
Mailing Address - City:CRANE
Mailing Address - State:MO
Mailing Address - Zip Code:65633
Mailing Address - Country:US
Mailing Address - Phone:417-369-0080
Mailing Address - Fax:
Practice Address - Street 1:92 NW STATE ROUTE 58
Practice Address - Street 2:
Practice Address - City:CENTERVIEW
Practice Address - State:MO
Practice Address - Zip Code:64019-9235
Practice Address - Country:US
Practice Address - Phone:660-656-3897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12026282OtherASHA ACCOUNT NUMBER