Individual
KIM STACY BALDWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD LP
Contact information
Practice address
1407 W 4TH ST, RED WING, MN 55066-2108
(651) 267-5000
Mailing address
32073 LAKEVIEW DR, LAKE CITY, MN 55041-3256
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP1728
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
365352800
—
MN
Enumeration date
02/20/2006
Last updated
02/11/2021
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