Provider Demographics
NPI:1801269816
Name:BAUMGARTNER-PAREDES, KELLIE JO (SLPA)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:JO
Last Name:BAUMGARTNER-PAREDES
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 HOWE AVE
Mailing Address - Street 2:#107
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3361
Mailing Address - Country:US
Mailing Address - Phone:916-564-5010
Mailing Address - Fax:916-564-5260
Practice Address - Street 1:1337 HOWE AVE
Practice Address - Street 2:#107
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3361
Practice Address - Country:US
Practice Address - Phone:916-564-5010
Practice Address - Fax:916-564-5260
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22002355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant