MEDICARE: MS. JESSICA BAUMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	020330	NY
2	235Z00000X	Speech-Language Pathologist	06300	MD
3	235Z00000X	Speech-Language Pathologist	000309	DC

General Provider Information

NPI Number	:	1144509357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA BAUMAN

Provider Business Mailing Address
First Line	:	3260 HENRY HUDSON PKWY
Second Line	:	APT 2E
City	:	BRONX
State	:	NY
Zip	:	10463-3289
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 HENRY HUDSON PKWY
Second Line	:	APT 2E
City	:	BRONX
State	:	NY
Zip	:	10463-3289
Country	:	US
Telephone Number	:	405-408-6934
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2011
Last Update Date	:	08/05/2011

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Directions to “ MS. JESSICA BAUMAN ” Practice Location

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