Provider Demographics
NPI:1679399919
Name:BAUMGART, MADISON (MS)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:BAUMGART
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1764 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-9010
Mailing Address - Country:US
Mailing Address - Phone:715-351-0613
Mailing Address - Fax:
Practice Address - Street 1:516 MCCLELLAN ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4844
Practice Address - Country:US
Practice Address - Phone:715-226-6441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7801226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health