Provider Demographics
NPI:1770032484
Name:BALDWIN, LYDIA (SLP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 MARY CT
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76262-9339
Mailing Address - Country:US
Mailing Address - Phone:254-625-2277
Mailing Address - Fax:
Practice Address - Street 1:1406 MARY CT
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76262-9339
Practice Address - Country:US
Practice Address - Phone:254-625-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108724235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist