Most Relevant Information
Provider Data
| NPI Number: | 1003026428 |
| Provider Name: | JENNIFER ELLEN BAUCOM MCD CCC-SLP |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | 2002000259 |
Most Important Dates
| Enumeration Date: | 05/23/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
603 E SUMMIT ST
DONIPHAN
MO
639351142
Practice Location Phone/Fax
| Phone: | 5739963982 |
| Fax: |
Provider Mailing Location
603 E SUMMIT ST
DONIPHAN
MO
639351142
Provider Mailing Phone/Fax
| Phone: | 5739963982 |
| Fax: |