Provider Demographics
NPI:1760571285
Name:BALDWIN, TRICIA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:NEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:1015 S BROADWAY
Mailing Address - Street 2:SUITE 18
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4667
Mailing Address - Country:US
Mailing Address - Phone:701-857-8500
Mailing Address - Fax:701-857-8555
Practice Address - Street 1:20 1ST AVE SW STE 202
Practice Address - Street 2:NORTHERN PLAINS CHILDREN'S ADVOCACY CENTER
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3812
Practice Address - Country:US
Practice Address - Phone:701-852-0836
Practice Address - Fax:701-852-0623
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND39601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1760571285OtherBLUE CROSS BLUE SHIELD
ND19261Medicaid
ND1760571285Medicare PIN