Basic Information
| Provider Information | |||||||||
| NPI: | 1790719276 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALDRIDGE | ||||||||
| FirstName: | MINNIE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | AUD, CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6700 WASHINGTON AVENUE SOUTH | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553443405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123511529 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15939 W 65TH ST | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132488971 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 1952 | KS | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | 1952 | KS | N | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | 1952 | KS | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2001004845 | 01 | MO | MISSOURI LICENSE | OTHER |