Provider Demographics
NPI:1568734515
Name:BAKER, STEPHEN RANDALL (NC LIC #788)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RANDALL
Last Name:BAKER
Suffix:
Gender:M
Credentials:NC LIC #788
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13313 OCEAN HWY UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-8544
Mailing Address - Country:US
Mailing Address - Phone:843-235-8098
Mailing Address - Fax:
Practice Address - Street 1:13313 OCEAN HWY UNIT 2
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-8544
Practice Address - Country:US
Practice Address - Phone:843-235-8098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC788237700000X
SC698237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC698OtherDHEC STATE LICENSE
NC778OtherSTATE LICENSE