=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700032604
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA ANNE BALDWIN PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2008
-----------------------------------------------------
Last Update Date | 08/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 E WILLAMETTE AVE
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80903-4944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-635-8894
-----------------------------------------------------
Fax | 719-487-8037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2502
-----------------------------------------------------
City | MONUMENT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80132-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-635-8894
-----------------------------------------------------
Fax | 719-487-8037
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 1134
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------