Provider Demographics
NPI:1437129806
Name:BAUMGARDNER, KAYE M (MS CCC-SLP, COM, CLC)
Entity type:Individual
Prefix:
First Name:KAYE
Middle Name:M
Last Name:BAUMGARDNER
Suffix:
Gender:F
Credentials:MS CCC-SLP, COM, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5356 CHOWEN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2122
Mailing Address - Country:US
Mailing Address - Phone:612-209-5240
Mailing Address - Fax:
Practice Address - Street 1:15600 36TH AVE N STE 120
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3687
Practice Address - Country:US
Practice Address - Phone:763-595-0812
Practice Address - Fax:763-595-0824
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN 7607235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN30940100Medicaid