Individual
KELLY BAUMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071008887
IL
106H00000X
Marriage & Family Therapist
166.000207
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071008887
STATE LICENSE
IL
01
—
166.000207
STATE LICENSE NUMBER
IL
Enumeration date
08/12/2011
Last updated
05/21/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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