MEDICARE: BAILEE BALDWIN

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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	5147	SD

General Provider Information

NPI Number	:	1407462344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEE BALDWIN

Provider Business Mailing Address
First Line	:	1445 NORTH AVE
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783-1552
Country	:	US
Telephone Number	:	605-644-4170
Fax Number	:

Provider Business Practice Location Address
First Line	:	677 CATHEDRAL DR STE 201
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-7389
Country	:	US
Telephone Number	:	605-755-5276
Fax Number	:

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

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	10/31/2022

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Directions to “ BAILEE BALDWIN ” Practice Location

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