Basic Information
| Provider Information | |||||||||
| NPI: | 1073152633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUMGARTEL | ||||||||
| FirstName: | BRITNEY | ||||||||
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| Credential: | CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 WHITEWATER DR APT 1303 | ||||||||
| Address2: | |||||||||
| City: | IDAHO FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834025040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094129322 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1460 ELK CREEK DR | ||||||||
| Address2: | |||||||||
| City: | IDAHO FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834048237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085351286 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2019 | ||||||||
| LastUpdateDate: | 12/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/31/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.