MEDICARE: AUDREY BAKER M.A., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2750	OH

General Provider Information

NPI Number	:	1215350947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY BAKER M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	530 W TURKEYFOOT LAKE RD
Second Line	:
City	:	NEW FRANKLIN
State	:	OH
Zip	:	44319-3451
Country	:	US
Telephone Number	:	330-644-8469
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 W TURKEYFOOT LAKE RD
Second Line	:
City	:	NEW FRANKLIN
State	:	OH
Zip	:	44319-3451
Country	:	US
Telephone Number	:	330-644-8469
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2014
Last Update Date	:	01/31/2014

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Directions to “ AUDREY BAKER M.A., CCC-SLP” Practice Location

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