Individual
NICOLE MARIE BAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2411 PATHWAYS CROSSING, BELLEVILLE, IL 62221
(618) 355-4423
Mailing address
2411 PATHWAYS XING, BELLEVILLE, IL 62221-5885
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
841408
IL
Other
Enumeration date
08/16/2017
Last updated
08/16/2017
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