Provider Demographics
NPI:1386069797
Name:BAKER, STEPHANIE LEANNE
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEANNE
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 AZTEC TRL
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-3206
Mailing Address - Country:US
Mailing Address - Phone:606-875-6992
Mailing Address - Fax:
Practice Address - Street 1:307 AZTEC TRL
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3206
Practice Address - Country:US
Practice Address - Phone:606-875-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist