MEDICARE: MRS. MARY JANE BAKER

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	85S	KY

General Provider Information

NPI Number	:	1417924911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY JANE BAKER

Provider Business Mailing Address
First Line	:	3418 FRANKFORT AVE
Second Line	:	STE 345
City	:	LOUISVILLE
State	:	KY
Zip	:	40207
Country	:	US
Telephone Number	:	502-891-8878
Fax Number	:	502-891-8865

Provider Business Practice Location Address
First Line	:	3418 FRANKFORT AVE
Second Line	:	STE 345
City	:	LOUISVILLE
State	:	KY
Zip	:	40207
Country	:	US
Telephone Number	:	502-891-8878
Fax Number	:	502-891-8865

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	07/08/2007

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Directions to “ MRS. MARY JANE BAKER ” Practice Location

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