Provider Demographics
NPI:1982803854
Name:BAKER, KRISTEN DAVIS (SLP)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:DAVIS
Last Name:BAKER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2765 NEW COLLEGE WAY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-2869
Mailing Address - Country:US
Mailing Address - Phone:404-275-2807
Mailing Address - Fax:770-889-5584
Practice Address - Street 1:4080 MCGINNIS FERRY ROAD
Practice Address - Street 2:BLDG.300, STE.302
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3948
Practice Address - Country:US
Practice Address - Phone:678-992-1935
Practice Address - Fax:770-889-5584
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005267235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist