Healthcare Provider Details

I. General information

NPI: 1477596187
Provider Name (Legal Business Name): JANELLE B BALDWIN NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANELLE B BEHM PTA

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1366 CANDLELIGHT LN
FOND DU LAC WI
54937-7537
US

IV. Provider business mailing address

1366 CANDLELIGHT LN
FOND DU LAC WI
54937-7537
US

V. Phone/Fax

Practice location:
  • Phone: 920-933-0856
  • Fax:
Mailing address:
  • Phone: 920-933-0856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number931-019
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberIDA-3449601
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: