Provider Demographics
NPI:1659546059
Name:BALDWIN, ANNETTE (MS,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANNETTE
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5000 WHITE TAIL WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47124-9517
Mailing Address - Country:US
Mailing Address - Phone:812-923-1078
Mailing Address - Fax:812-923-1078
Practice Address - Street 1:5000 WHITE TAIL WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IN
Practice Address - Zip Code:47124-9517
Practice Address - Country:US
Practice Address - Phone:812-923-1078
Practice Address - Fax:812-923-1078
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003324A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist