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General NPI Number Information
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NPI Number | 1265002109
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Entity Type | Individual
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Provider Name | KATHRYN ARIELLE VLIETSTRA BAKER AU.D.
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Gender | Female
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Dates
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Enumeration Date | 07/01/2021
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 4772 EUCLID RD STE C
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3800
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Country | US
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Telephone | 757-272-1694
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Fax |
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Provider Business Mailing Address
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Address Line | 103 WINDHAM RD
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City | NORFOLK
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State | VA
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Zip | 23505-4822
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Country | US
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Telephone | 920-946-8365
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2201001837
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License Number State | VA
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