Basic Information
| Provider Information | |||||||||
| NPI: | 1801269816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUMGARTNER-PAREDES | ||||||||
| FirstName: | KELLIE | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | SLPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1337 HOWE AVE | ||||||||
| Address2: | #107 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958253361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165645010 | ||||||||
| FaxNumber: | 9165645260 | ||||||||
| Practice Location | |||||||||
| Address1: | 1337 HOWE AVE | ||||||||
| Address2: | #107 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958253361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165645010 | ||||||||
| FaxNumber: | 9165645260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2015 | ||||||||
| LastUpdateDate: | 11/12/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | 2200 | CA | Y | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
No ID Information.