Healthcare Provider Details

I. General information

NPI: 1598364119
Provider Name (Legal Business Name): BARRY BAKER SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 KIMBERLY LN
WILLIAMSTOWN KY
41097-9458
US

IV. Provider business mailing address

PO BOX 54455
CINCINNATI OH
45254-0455
US

V. Phone/Fax

Practice location:
  • Phone: 859-824-7803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11250
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: