Provider Demographics
NPI:1265653646
Name:BALDWIN, THERESA L (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:L
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:VOGEDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17424 E CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-8449
Mailing Address - Country:US
Mailing Address - Phone:602-418-3566
Mailing Address - Fax:
Practice Address - Street 1:9385 W DONALD DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2988
Practice Address - Country:US
Practice Address - Phone:602-875-5616
Practice Address - Fax:623-227-2030
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist