Healthcare Provider Details

I. General information

NPI: 1902135734
Provider Name (Legal Business Name): SUSAN M. BALDWIN MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 STAFFORD LN
DELTA CO
81416-2273
US

IV. Provider business mailing address

4261 COLOROW RD
OLATHE CO
81425-9555
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-6428
  • Fax:
Mailing address:
  • Phone: 970-323-5035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: