Healthcare Provider Details

I. General information

NPI: 1295852309
Provider Name (Legal Business Name): MARY PATRICIA BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 ADAMS LN
RICHMOND KY
40475-8765
US

IV. Provider business mailing address

129 ADAMS LN
RICHMOND KY
40475-8765
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-6171
  • Fax:
Mailing address:
  • Phone: 859-623-6171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0338
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: