MEDICARE: MRS. DEBORAH S BALDRIGE RN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	#C 0007745	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7866699	OTHER	OH	AETNA PIN

General Provider Information

NPI Number	:	1265597421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH S BALDRIGE RN LPC

Provider Business Mailing Address
First Line	:	1277 SHADY LAKES DR
Second Line	:
City	:	KENT
State	:	OH
Zip	:	44240
Country	:	US
Telephone Number	:	330-346-0395
Fax Number	:

Provider Business Practice Location Address
First Line	:	1469 S MAIN ST
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4245
Country	:	US
Telephone Number	:	330-499-3065
Fax Number	:	330-499-2497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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