Healthcare Provider Details

I. General information

NPI: 1346652088
Provider Name (Legal Business Name): CHRISTINE M BAUMGARDNER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE M. KEMPER LISW

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 TOLOWA TRL
LIMA OH
45805-4124
US

IV. Provider business mailing address

143 TOLOWA TRL
LIMA OH
45805-4124
US

V. Phone/Fax

Practice location:
  • Phone: 419-306-9290
  • Fax:
Mailing address:
  • Phone: 419-306-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI 1600290
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1201251
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: