Provider Demographics
NPI:1477596187
Name:BALDWIN, JANELLE B (NBC-HWC)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:B
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:B
Other - Last Name:BEHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1366 CANDLELIGHT LN
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-7537
Mailing Address - Country:US
Mailing Address - Phone:920-933-0856
Mailing Address - Fax:
Practice Address - Street 1:1366 CANDLELIGHT LN
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-7537
Practice Address - Country:US
Practice Address - Phone:920-933-0856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI931-019225200000X
WIIDA-3449601171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40356300Medicaid