Provider Demographics
NPI:1598177081
Name:BALDWIN, JENNIE STILES
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:STILES
Last Name:BALDWIN
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 1:2008 SIMOND AVE APT D
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-4555
Mailing Address - Country:US
Mailing Address - Phone:512-850-5697
Mailing Address - Fax:888-977-1968
Practice Address - Street 1:11651 JOLLYVILLE RD STE 150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4106
Practice Address - Country:US
Practice Address - Phone:512-850-5697
Practice Address - Fax:888-977-1968
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01458171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist