Healthcare Provider Details

I. General information

NPI: 1144187873
Provider Name (Legal Business Name): SOPHIA BAUMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 MORTENSEN RD STE 101
AMES IA
50014-5534
US

IV. Provider business mailing address

4720 MORTENSEN RD STE 101
AMES IA
50014-5534
US

V. Phone/Fax

Practice location:
  • Phone: 515-599-8904
  • Fax:
Mailing address:
  • Phone: 515-599-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number120442
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: