Provider Demographics
NPI:1629131487
Name:BALDWIN, STACEY M (AUD CCC A)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:M
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:AUD CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 MISSION RD STE 146
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3005
Mailing Address - Country:US
Mailing Address - Phone:913-384-2105
Mailing Address - Fax:913-384-0735
Practice Address - Street 1:7301 MISSION RD STE 140
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3005
Practice Address - Country:US
Practice Address - Phone:913-262-5855
Practice Address - Fax:913-262-5869
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1994231H00000X
KS1325231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist