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NPI Code Detail

MEDICARE: ICELYNN BALDWIN LISW-CP

MEDICARE: ICELYNN BALDWIN LISW-CP
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
11041C0700XClinical Social Worker10175SC
2104100000XSocial Worker10175SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
210175OTHERSCCLINICAL LICENSE

General Provider Information

NPI Number : 1649667312
Entity Type Code : Individual
Provider Name (Legal Business Name) : ICELYNN BALDWIN LISW-CP
Provider Business Mailing Address
First Line : 1154 SUNNYSIDE DR
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-3387
Country : US
Telephone Number : 803-730-1023
Fax Number :
Provider Business Practice Location Address
First Line : 1154 SUNNYSIDE DR
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-3387
Country : US
Telephone Number : 803-730-1023
Fax Number : 803-667-4697
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2015
Last Update Date : 04/22/2020

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