Healthcare Provider Details

I. General information

NPI: 1093933764
Provider Name (Legal Business Name): SHELLY LYNN BAXTER MA,PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 AICHOLTZ RD
CINCINNATI OH
45244
US

IV. Provider business mailing address

4629 AICHOLTZ RD
CINCINNATI OH
45244
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax: 513-753-2144
Mailing address:
  • Phone: 513-752-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0500003
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: