Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | LP3526 | MN |
NPI | 1003879677 |
---|---|
Provider Name | Mr. John Edward Baumgart |
First Address | Anoka, MN 55303 |
Second Address | Anoka, MN 55303-1430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 09/07/2007 |