Healthcare Provider Details

I. General information

NPI: 1548463979
Provider Name (Legal Business Name): BAKER CONSULTING SERVICES GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 BRANDIE ST
TUTTLE OK
73089-7519
US

IV. Provider business mailing address

850 BRANDIE ST
TUTTLE OK
73089-7519
US

V. Phone/Fax

Practice location:
  • Phone: 405-392-3182
  • Fax:
Mailing address:
  • Phone: 405-392-3182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2750
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. SARAH M BAKER
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MS CCC-SLP
Phone: 405-392-3183