Provider Demographics
NPI:1386078707
Name:BAKER, DANIELLE ASHLEY (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:ASHLEY
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:ASHLEY
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1717 SE 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3115
Mailing Address - Country:US
Mailing Address - Phone:503-568-1781
Mailing Address - Fax:503-710-9534
Practice Address - Street 1:1717 SE 43RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3115
Practice Address - Country:US
Practice Address - Phone:503-568-1781
Practice Address - Fax:503-710-9534
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109321235Z00000X
OR15419235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500687686Medicaid
OR15419OtherOREGON STATE BOARD OF LICENSURE FOR SPEECH PATHOLOGY AND AUDIOLOGY