Healthcare Provider Details

I. General information

NPI: 1508881517
Provider Name (Legal Business Name): BETH CLOYD BAKER CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 JENNINGS ST
WEBER CITY VA
24290
US

IV. Provider business mailing address

340 E JACKSON ST
GATE CITY VA
24251-3526
US

V. Phone/Fax

Practice location:
  • Phone: 276-386-7981
  • Fax:
Mailing address:
  • Phone: 276-386-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2203000633
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: