Healthcare Provider Details

I. General information

NPI: 1639399934
Provider Name (Legal Business Name): DAWN M BAUMGARTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN M KOSNOSKI

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 N IDAHO RD
APACHE JUNCTION AZ
85219-4002
US

IV. Provider business mailing address

PO BOX 3160
APACHE JUNCTION AZ
85217-3160
US

V. Phone/Fax

Practice location:
  • Phone: 520-689-2457
  • Fax: 520-689-2745
Mailing address:
  • Phone: 480-288-5328
  • Fax: 480-288-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12252
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: