Healthcare Provider Details

I. General information

NPI: 1730098617
Provider Name (Legal Business Name): DEREK BAKER ED.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14709 RIDGE RD
NORTH ROYALTON OH
44133-4943
US

IV. Provider business mailing address

14709 RIDGE RD
NORTH ROYALTON OH
44133-4943
US

V. Phone/Fax

Practice location:
  • Phone: 440-582-9120
  • Fax:
Mailing address:
  • Phone: 440-582-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.02198
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: