Healthcare Provider Details

I. General information

NPI: 1629700422
Provider Name (Legal Business Name): KIM BALDWIN PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W JEFFERSON ST STE 304
BLOOMINGTON IL
61701-3969
US

IV. Provider business mailing address

207 W JEFFERSON ST STE 304
BLOOMINGTON IL
61701-3969
US

V. Phone/Fax

Practice location:
  • Phone: 309-204-6614
  • Fax:
Mailing address:
  • Phone: 309-204-6614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. KIM BALDWIN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 309-204-6614