Healthcare Provider Details

I. General information

NPI: 1760571285
Provider Name (Legal Business Name): TRICIA BALDWIN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRICIA NEISS MSW, LICSW

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 1ST AVE SW STE 202 NORTHERN PLAINS CHILDREN'S ADVOCACY CENTER
MINOT ND
58701-3812
US

IV. Provider business mailing address

1015 S BROADWAY SUITE 18
MINOT ND
58701-4667
US

V. Phone/Fax

Practice location:
  • Phone: 701-852-0836
  • Fax: 701-852-0623
Mailing address:
  • Phone: 701-857-8500
  • Fax: 701-857-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3960
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1760571285
Identifier TypeOTHER
Identifier StateND
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier19261
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: