Provider Demographics
NPI:1316405319
Name:BAALMAN, ROIAN MARIE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:ROIAN
Middle Name:MARIE
Last Name:BAALMAN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:ROIAN
Other - Middle Name:MARIE
Other - Last Name:WILBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLPC
Mailing Address - Street 1:1300 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4264
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:417-761-5065
Practice Address - Street 1:210 N WILLIAMS ST UNIT C
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-1583
Practice Address - Country:US
Practice Address - Phone:660-263-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019007105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
14416475OtherCAQH
MO490067290Medicaid