Provider Demographics
NPI:1932714110
Name:MAYBERRY BAUMGARTNER, NATALIE SUZANNE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:SUZANNE
Last Name:MAYBERRY BAUMGARTNER
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 1:318 W 125TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4996
Mailing Address - Country:US
Mailing Address - Phone:918-724-5597
Mailing Address - Fax:
Practice Address - Street 1:12018 S ELM ST STE 111
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3653
Practice Address - Country:US
Practice Address - Phone:918-724-5597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5316235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist