Healthcare Provider Details

I. General information

NPI: 1336451731
Provider Name (Legal Business Name): KATHERINE J BAUM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BENMONT AVE SUITE 20
BENNINGTON VT
05201-1873
US

IV. Provider business mailing address

242 WILLOW RD
BENNINGTON VT
05201-8038
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-3520
  • Fax: 802-447-3392
Mailing address:
  • Phone: 802-442-3520
  • Fax: 802-447-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0480000854
License Number StateVT

VIII. Authorized Official

Name: JENNIFER PARE
Title or Position: BILLER
Credential:
Phone: 802-773-0250