Kelly Ann Baumgarden, HSPP
Individual provider Active NPI Clinical Psychologist · Fort Wayne, IN
NPI 1356645873 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1356645873
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 20043122A (IN)
- Practice address
- 2100 Goshen Rd
Fort Wayne, IN 46808-1493 - Phone
- (260) 471-3500
- Fax
- (260) 471-4263
- NPI assigned
- Dec 23, 2010
- 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)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 20043122A | IN | Yes |
Addresses
Primary practice location
2100 Goshen Rd
Fort Wayne, IN 46808-1493
Mailing address
2621 E Jefferson St
Warsaw, IN 46580-3880
Phone (574) 267-7169
Other practice location 1
227 E Main St
Festus, MO 63028-1952
Phone (636) 321-0101
Other providers in Fort Wayne, IN
- Melissa Lynn Baughman
- Blake Bauman
- Laramie G Bauman
- Tiffany J. Bauman
- Delaney Baumann
- Kailyn Baumgartner
- Kevin Martin Baumgartner
- Curt Edward Baumle
- Terah Bautista
- Angela K Baxter
All providers in Fort Wayne, IN · Clinical Psychologist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.