Doctor Name: | JENNIFER ELLEN BAUCOM |
NPI Number: | 1003026428 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MCD CCC-SLP |
License Number: | 2002000259 |
Business Practice Address: | 603 E Summit St Doniphan, MO - 639351142 |
Business Phone Number: | 5739963982 |
Business Fax Number: | |
Mailing Address: | 603 E Summit St, DONIPHAN |
State: | MO |
Postal Code: | 639351142 |
Phone Number: | 5739963982 |
Fax Number: | |
NPI Enumeration Date: | 05/23/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2002000259 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |