Healthcare Provider Details

I. General information

NPI: 1154141992
Provider Name (Legal Business Name): MOLLIE BALDUS M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S MOORE ST
BLUE EARTH MN
56013-2158
US

IV. Provider business mailing address

814 S ORIENT ST
FAIRMONT MN
56031-4344
US

V. Phone/Fax

Practice location:
  • Phone: 507-526-7388
  • Fax:
Mailing address:
  • Phone: 605-569-6013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number528745
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: