Provider Demographics
NPI:1184802621
Name:BAUMGARDNER BARNES, JENNIFER ANN (MSW, LICSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:BAUMGARDNER BARNES
Suffix:
Gender:F
Credentials:MSW, LICSW, LCSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:BAUMGARDNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW, LCSW
Mailing Address - Street 1:1409 WILLOW ST
Mailing Address - Street 2:STE 109
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2241
Mailing Address - Country:US
Mailing Address - Phone:651-261-6599
Mailing Address - Fax:877-610-7999
Practice Address - Street 1:1409 WILLOW ST
Practice Address - Street 2:STE 109
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2241
Practice Address - Country:US
Practice Address - Phone:612-474-1700
Practice Address - Fax:612-474-1710
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16811041C0700X
MN174131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000152564Medicaid