Provider Demographics
NPI:1194052886
Name:BAXTER, LINDA MAE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MAE
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:MAE
Other - Last Name:MCKINNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3181 SANDHILL RD.
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9425
Mailing Address - Country:US
Mailing Address - Phone:517-336-6060
Mailing Address - Fax:517-336-6050
Practice Address - Street 1:3181 SANDHILL RD.
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-9425
Practice Address - Country:US
Practice Address - Phone:517-336-6060
Practice Address - Fax:517-336-6050
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01070306(ASHA)235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist