Provider Demographics
NPI:1215350947
Name:BAKER, AUDREY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W TURKEYFOOT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44319-3451
Mailing Address - Country:US
Mailing Address - Phone:330-644-8469
Mailing Address - Fax:
Practice Address - Street 1:530 W TURKEYFOOT LAKE RD
Practice Address - Street 2:
Practice Address - City:NEW FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:44319-3451
Practice Address - Country:US
Practice Address - Phone:330-644-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist