Healthcare Provider Details

I. General information

NPI: 1710396502
Provider Name (Legal Business Name): SUZANNE JANE BAKER MA.ED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S COLLEGE AVE
SALEM VA
24153-5165
US

IV. Provider business mailing address

2546 MOUNT TABOR RD
BLACKSBURG VA
24060-8918
US

V. Phone/Fax

Practice location:
  • Phone: 540-387-3977
  • Fax:
Mailing address:
  • Phone: 540-808-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005850
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: