Provider Demographics
NPI:1417279811
Name:BALDWIN, SHEVONNE C (CI/CT)
Entity type:Individual
Prefix:
First Name:SHEVONNE
Middle Name:C
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:CI/CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 STEPHANIE RD
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-9187
Mailing Address - Country:US
Mailing Address - Phone:509-306-9037
Mailing Address - Fax:509-962-1444
Practice Address - Street 1:160 STEPHANIE RD
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-9187
Practice Address - Country:US
Practice Address - Phone:509-306-9037
Practice Address - Fax:509-962-1444
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602644821171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter