Provider Demographics
NPI:1851635254
Name:BAIDEL, CONSTANCE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:
Last Name:BAIDEL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 THORNBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-1422
Mailing Address - Country:US
Mailing Address - Phone:419-356-8358
Mailing Address - Fax:
Practice Address - Street 1:5415 THORNBROOK TRL
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-1422
Practice Address - Country:US
Practice Address - Phone:419-356-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP8203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist