Provider Demographics
NPI:1962623041
Name:BALDWIN, SHELLI
Entity type:Individual
Prefix:
First Name:SHELLI
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 POINTER TRL W STE E
Mailing Address - Street 2:SUITE E
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-2241
Mailing Address - Country:US
Mailing Address - Phone:479-471-1290
Mailing Address - Fax:479-474-5182
Practice Address - Street 1:11 POINTER TRL W STE E
Practice Address - Street 2:SUITE E
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-2241
Practice Address - Country:US
Practice Address - Phone:479-471-1290
Practice Address - Fax:479-474-5182
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146030721Medicaid