Provider Demographics
NPI:1396997854
Name:BAKER, SANDRA LYNN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYNN
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 1:805 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46017-1435
Mailing Address - Country:US
Mailing Address - Phone:765-378-5137
Mailing Address - Fax:765-378-5137
Practice Address - Street 1:805 HAMPTON LN
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:IN
Practice Address - Zip Code:46017-1435
Practice Address - Country:US
Practice Address - Phone:765-378-5137
Practice Address - Fax:765-378-5137
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004724A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist