MEDICARE: OLIVIA 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

General Provider Information

NPI Number	:	1720667900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA BAKER

Provider Business Mailing Address
First Line	:	2551 E 68TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-1377
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6440 W 34TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-1138
Country	:	US
Telephone Number	:	765-491-4103
Fax Number	:

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

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	04/24/2024

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Directions to “ OLIVIA BAKER ” Practice Location

Language	Start Address	Practice Location

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