MEDICARE: TRACY JO BAUMAN M.ED

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1992092332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY JO BAUMAN M.ED

Provider Business Mailing Address
First Line	:	1467 TERRANCE DR
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-4147
Country	:	US
Telephone Number	:	630-399-9018
Fax Number	:	630-787-0484

Provider Business Practice Location Address
First Line	:	1467 TERRANCE DR
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-4147
Country	:	US
Telephone Number	:	630-399-9018
Fax Number	:	630-787-0484

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

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	07/06/2011

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