NPI 1174802730 · live from the CMS NPI Registry
Kelly Bauman, Psy.D
Psychologist, Clinical in Crystal Lake, IL. National Provider Identifier 1174802730, active.
NPI record
| NPI | 1174802730 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychologist, Clinical 103TC0700X |
| Practice location | 457 Coventry Ln Ste 115, Crystal Lake, IL 60014 |
| Practice phone | 815-245-4825 |
| Mailing address | 720 S Eastwood Dr Ste 166, Woodstock, IL 60098 |
| Enumerated | August 12, 2011 |
| Last updated | May 21, 2021 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Marriage & Family Therapist | 106H00000X | 166.000207 (IL) |
| Psychologist, Clinical primary | 103TC0700X | 071008887 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.