Provider Demographics
NPI:1912278763
Name:BAKER, LAYLA JADE (ME)
Entity type:Individual
Prefix:
First Name:LAYLA
Middle Name:JADE
Last Name:BAKER
Suffix:
Gender:F
Credentials:ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9860 S THOMAS DR
Mailing Address - Street 2:UNIT 607
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-1200
Mailing Address - Country:US
Mailing Address - Phone:229-522-0812
Mailing Address - Fax:
Practice Address - Street 1:1937 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4510
Practice Address - Country:US
Practice Address - Phone:850-769-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist