MEDICARE: DIANE J. BAUMBACH L.I.S.W

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	1041C0700X	Clinical Social Worker	00040	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01865	OTHER	IA	BLUE CROSS/BLUE SHIELD OF
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548269475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE J. BAUMBACH L.I.S.W

Provider Business Mailing Address
First Line	:	320 KIRKWOOD AVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4754
Country	:	US
Telephone Number	:	319-351-6654
Fax Number	:	319-339-0905

Provider Business Practice Location Address
First Line	:	320 KIRKWOOD AVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4754
Country	:	US
Telephone Number	:	319-351-6654
Fax Number	:	319-339-0905

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/08/2007

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