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General NPI Number Information
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NPI Number | 1811613896
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Entity Type | Individual
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Provider Name | OLIVIA BAKER SLP
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Gender | Female
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Dates
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Enumeration Date | 10/12/2022
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 2880 WILSON AVE SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1221
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Country | US
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Telephone | 616-300-5495
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Fax |
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Provider Business Mailing Address
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Address Line | 804 CHATHAM ST NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-5659
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Country | US
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Telephone | 248-622-0689
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101008209
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License Number State | MI
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