Healthcare Provider Details

I. General information

NPI: 1316711567
Provider Name (Legal Business Name): NINA A WALLES-BALDWIN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NINA A WALLES

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S PARK AVE
SPRINGFIELD MO
65802-4855
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 417-893-7735
  • Fax:
Mailing address:
  • Phone: 417-761-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2026002815
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: