Jennifer Ellen Baucom, MCD CCC-SLP

Key facts

NPI

1003026428

Entity type

Individual (NPI type 1)

Primary specialty

Speech-Language Pathologist 235Z00000X

License

2002000259 (MO)

Practice address

603 E Summit St
Doniphan, MO 63935-1142

Phone

(573) 996-3982

NPI assigned

May 23, 2007

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003026428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 E SUMMIT ST",
            "city": "DONIPHAN",
            "state": "MO",
            "postal_code": "639351142",
            "telephone_number": "573-996-3982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 E SUMMIT ST",
            "city": "DONIPHAN",
            "state": "MO",
            "postal_code": "639351142",
            "telephone_number": "573-996-3982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUCOM",
        "first_name": "JENNIFER",
        "middle_name": "ELLEN",
        "credential": "MCD CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2002000259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Doniphan, MO

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All providers in Doniphan, MO · Speech-Language Pathologist in Missouri