| Doctor Name: | JAQLYN R BALDWIN |
| NPI Number: | 1548646581 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | I-08304 |
| Business Practice Address: | 405 N Date St Suite 8 Truth Or Consequences, NM - 879012377 |
| Business Phone Number: | 5758947589 |
| Business Fax Number: | 5758947584 |
| Mailing Address: | 405 N Date St, Suite 8 TRUTH OR CONSEQUENCES |
| State: | NM |
| Postal Code: | 879012377 |
| Phone Number: | 5758947589 |
| Fax Number: | 5758947584 |
| NPI Enumeration Date: | 07/31/2015 |
| NPI Last Update Date: | 07/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | I-08304 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |