Provider Demographics
NPI:1982811394
Name:BALDWIN-WILSON, GLORIA D (LMSW)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:D
Last Name:BALDWIN-WILSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ALLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3702
Mailing Address - Country:US
Mailing Address - Phone:269-344-7125
Mailing Address - Fax:
Practice Address - Street 1:918 JASPER ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2853
Practice Address - Country:US
Practice Address - Phone:269-382-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010359571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical