Provider Demographics
NPI:1730283748
Name:BALDWIN, BRAD WAYNE (AUD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:WAYNE
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 LAKE BOONE TRAIL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7511
Mailing Address - Country:US
Mailing Address - Phone:919-782-7112
Mailing Address - Fax:919-789-9560
Practice Address - Street 1:4201 LAKE BOONE TRAIL
Practice Address - Street 2:SUITE 105
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7511
Practice Address - Country:US
Practice Address - Phone:919-782-7112
Practice Address - Fax:919-789-9560
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4821231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist