Provider Demographics
NPI:1821458019
Name:BAUMGARTLE, RICK (BS CADCII)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:BAUMGARTLE
Suffix:
Gender:M
Credentials:BS CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9660 SW DENNEY RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6066
Mailing Address - Country:US
Mailing Address - Phone:503-577-8072
Mailing Address - Fax:
Practice Address - Street 1:9660 SW DENNEY RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6066
Practice Address - Country:US
Practice Address - Phone:503-577-8072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11-03-51101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR11-03-51OtherCADCII