Healthcare Provider Details

I. General information

NPI: 1235586694
Provider Name (Legal Business Name): REGINA BALDWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KIRKWOOD RD SUITE 150
KIRKWOOD MO
63122-7254
US

IV. Provider business mailing address

10109 GRANT MEADOW LN
SAINT LOUIS MO
63123-6282
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-7554
  • Fax: 314-821-0048
Mailing address:
  • Phone: 314-544-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01997
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: