1528303898 NPI number — JESSICA ELIZABETH BALDWIN BCBA

Table of content: JESSICA ELIZABETH BALDWIN BCBA (NPI 1528303898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528303898 NPI number — JESSICA ELIZABETH BALDWIN BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALDWIN
Provider First Name:
JESSICA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DORNSEIF
Provider Other First Name:
JESSICA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528303898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
349 YORK RD
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
WILLOW GROVE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19090-2660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-477-6587
Provider Business Mailing Address Fax Number:
215-657-2927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
349 YORK RD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
WILLOW GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19090-2660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-477-6587
Provider Business Practice Location Address Fax Number:
215-657-2927
Provider Enumeration Date:
11/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-12-12035 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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