Individual
KELLY BAUMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D
Contact information
Practice address
457 COVENTRY LN STE 115, CRYSTAL LAKE, IL 60014-7571
(815) 245-4825
(815) 596-1008
Mailing address
720 S EASTWOOD DR STE 166, WOODSTOCK, IL 60098-4635
(815) 245-4825
(815) 596-1008
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
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