Provider Demographics
NPI:1992929756
Name:BAKER, MARI AGNES (HIS)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:AGNES
Last Name:BAKER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 WASHINGTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4238
Mailing Address - Country:US
Mailing Address - Phone:414-442-6000
Mailing Address - Fax:414-442-8378
Practice Address - Street 1:3180 N 124TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-4062
Practice Address - Country:US
Practice Address - Phone:414-442-6000
Practice Address - Fax:414-442-8378
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-1057237700000X
WI1120237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist