Healthcare Provider Details

I. General information

NPI: 1467964569
Provider Name (Legal Business Name): COURTNEY BALDWIN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SWEETWATER AVE
GLENDALE AZ
85304-1505
US

IV. Provider business mailing address

4650 W SWEETWATER AVE
GLENDALE AZ
85304-1505
US

V. Phone/Fax

Practice location:
  • Phone: 602-347-2600
  • Fax:
Mailing address:
  • Phone: 602-347-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP16999
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: