Healthcare Provider Details

I. General information

NPI: 1710562814
Provider Name (Legal Business Name): KATELYN ELIZABETH BAKER PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FAIRMONT AVE
FAIRMONT WV
26554-2710
US

IV. Provider business mailing address

104 CARDINAL PL
FAIRMONT WV
26554-1412
US

V. Phone/Fax

Practice location:
  • Phone: 681-404-6869
  • Fax:
Mailing address:
  • Phone: 219-765-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: