Provider Demographics
NPI:1659993327
Name:BALDRIDGE, ALISON DIANE (MED, RBT, BCBA)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:DIANE
Last Name:BALDRIDGE
Suffix:
Gender:F
Credentials:MED, RBT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13145 N HWY 183 APT 937
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3293
Mailing Address - Country:US
Mailing Address - Phone:832-247-4217
Mailing Address - Fax:
Practice Address - Street 1:11623 ANGUS RD STE E20
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4003
Practice Address - Country:US
Practice Address - Phone:512-827-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst