Healthcare Provider Details

I. General information

NPI: 1689044935
Provider Name (Legal Business Name): KEN BAUMGARTNER BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 E SPEEDWAY BLVD STE 401
TUCSON AZ
85710-1220
US

IV. Provider business mailing address

315 W VALENCIA RD PMB 24213
TUCSON AZ
85734-4601
US

V. Phone/Fax

Practice location:
  • Phone: 877-881-3090
  • Fax:
Mailing address:
  • Phone: 520-954-1289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-000333
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: