Provider Demographics
NPI:1942744487
Name:BAUMAN, KIMBERLEE
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7823 87TH ST
Mailing Address - Street 2:NEW YORK, NY 11385
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:718-847-0724
Mailing Address - Fax:718-805-0737
Practice Address - Street 1:7823 87TH ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7655
Practice Address - Country:US
Practice Address - Phone:718-847-0724
Practice Address - Fax:718-805-0737
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106213235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist