Provider Demographics
NPI:1881091205
Name:BAUMGARTNER, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name: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:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:IA
Mailing Address - Zip Code:52052-0285
Mailing Address - Country:US
Mailing Address - Phone:563-362-2379
Mailing Address - Fax:563-334-7970
Practice Address - Street 1:3 GOETHE ST
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:IA
Practice Address - Zip Code:52052-9319
Practice Address - Country:US
Practice Address - Phone:563-362-2379
Practice Address - Fax:563-334-7970
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0756371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical