Healthcare Provider Details

I. General information

NPI: 1790719276
Provider Name (Legal Business Name): MINNIE J BALDRIDGE AUD, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8424 CLINT DR
BELTON MO
64012-5329
US

IV. Provider business mailing address

6528 RAYTOWN RD STE I
RAYTOWN MO
64133-5023
US

V. Phone/Fax

Practice location:
  • Phone: 816-322-8883
  • Fax:
Mailing address:
  • Phone: 816-737-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1952
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1952
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1952
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: