Provider Demographics
NPI:1609322148
Name:BALDWIN, DENA ANN
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:ANN
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 1:16585 MORENO PL
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-5019
Mailing Address - Country:US
Mailing Address - Phone:208-571-4163
Mailing Address - Fax:
Practice Address - Street 1:515 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2774
Practice Address - Country:US
Practice Address - Phone:208-642-6416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker