Provider Demographics
NPI:1528593548
Name:LEDYARD, LUCY BALDWIN
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:BALDWIN
Last Name:LEDYARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2533
Mailing Address - Country:US
Mailing Address - Phone:406-212-0515
Mailing Address - Fax:
Practice Address - Street 1:40 FOUR MILE DR STE 7
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2655
Practice Address - Country:US
Practice Address - Phone:406-314-4788
Practice Address - Fax:406-890-6708
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MT98559207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program