Healthcare Provider Details

I. General information

NPI: 1952955338
Provider Name (Legal Business Name): KELLY MARIE BAUMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 SUTTON BLVD STE 201
MAPLEWOOD MO
63143-3917
US

IV. Provider business mailing address

2073 SILVERWOOD LN
CHESTERFIELD MO
63017-7425
US

V. Phone/Fax

Practice location:
  • Phone: 314-781-7900
  • Fax:
Mailing address:
  • Phone: 516-729-7308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2018038119
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: