Provider Demographics
NPI:1255822342
Name:BALDWIN, SHAUN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-6406
Mailing Address - Country:US
Mailing Address - Phone:612-802-7110
Mailing Address - Fax:
Practice Address - Street 1:1600 N IH 35
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6984
Practice Address - Country:US
Practice Address - Phone:512-353-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111972235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist