| Doctor Name: | MR. JOHN EDWARD BAUMGART |
| NPI Number: | 1003879677 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S. |
| License Number: | LP3526 |
| Business Practice Address: | 903 Norwood Ave Anoka, MN - 553031430 |
| Business Phone Number: | 7634224170 |
| Business Fax Number: | |
| Mailing Address: | 903 Norwood Ave, ANOKA |
| State: | MN |
| Postal Code: | 55303 |
| Phone Number: | 7634224170 |
| Fax Number: | |
| NPI Enumeration Date: | 04/06/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | LP3526 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |