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NPI Code Detail

MEDICARE: JONATHAN BAUM LCSW

MEDICARE:   JONATHAN  BAUM  LCSW
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
11041C0700XClinical Social Worker6711MT

General Provider Information

NPI Number : 1184049785
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN BAUM LCSW
Provider Business Mailing Address
First Line : PO BOX 491
Second Line :
City : KILA
State : MT
Zip : 59920-0491
Country : US
Telephone Number : 406-471-2173
Fax Number : 406-890-6483
Provider Business Practice Location Address
First Line : 1077 WHITEFISH STAGE
Second Line :
City : KALISPELL
State : MT
Zip : 59901-2735
Country : US
Telephone Number : 406-471-2173
Fax Number : 406-890-6483
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2014
Last Update Date : 10/13/2020

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