Provider Demographics
NPI:1033682638
Name:BAUTERS, KRISTIE (MS)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:BAUTERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28853 LINCOLNVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5253
Mailing Address - Country:US
Mailing Address - Phone:810-844-3989
Mailing Address - Fax:
Practice Address - Street 1:4201 VARSITY DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-5005
Practice Address - Country:US
Practice Address - Phone:734-926-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician