Provider Demographics
NPI:1548582299
Name:BALDWIN, KATHLEEN ELLEN (MS, CGC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELLEN
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:2211 LOMAS BLVD. 3RD FLOOR
Practice Address - Street 2:UNM PEDIATRIC SPECIALTY CLINIC
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2719
Practice Address - Country:US
Practice Address - Phone:505-272-5200
Practice Address - Fax:505-272-5750
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMGC2009-013170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS