Provider Demographics
NPI:1629700422
Name:KIM BALDWIN PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:KIM BALDWIN PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:309-204-6614
Mailing Address - Street 1:207 W JEFFERSON ST STE 304
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3969
Mailing Address - Country:US
Mailing Address - Phone:309-204-6614
Mailing Address - Fax:
Practice Address - Street 1:207 W JEFFERSON ST STE 304
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3969
Practice Address - Country:US
Practice Address - Phone:309-204-6614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)