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General NPI Number Information
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NPI Number | 1740063502
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Entity Type | Individual
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Provider Name | LACEY KAYE BAKER
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Gender | Female
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 1707 LINWOOD DR
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City | PARAGOULD
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State | AR
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Zip | 72450-5364
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Country | US
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Telephone | 870-682-3397
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Fax |
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Provider Business Mailing Address
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Address Line | 7010 CHAD COLLEY BLVD APT 704
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City | FORT SMITH
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State | AR
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Zip | 72916-6408
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-79847
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License Number State | AR
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