Provider Demographics
NPI:1104875863
Name:BAKER, MELISSA ELLEN (CCC-A)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELLEN
Last Name:BAKER
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3824
Mailing Address - Country:US
Mailing Address - Phone:605-941-2472
Mailing Address - Fax:605-336-6010
Practice Address - Street 1:429 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-3824
Practice Address - Country:US
Practice Address - Phone:605-941-2472
Practice Address - Fax:605-306-5676
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
SD387A231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200835710Medicaid
IN000000343223OtherANTHEM
IN090350LMedicare PIN
INP00404404Medicare PIN