MEDICARE: KATELYN JOY 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	SP.14737	OH
2	235Z00000X	Speech-Language Pathologist	COND.20201596-SP	OH

General Provider Information

NPI Number	:	1962091777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN JOY BAKER

Provider Business Mailing Address
First Line	:	6203 OAKCREST AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-1141
Country	:	US
Telephone Number	:	330-620-6661
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 MANCHESTER AVE NW
Second Line	:
City	:	MASSILLON
State	:	OH
Zip	:	44647-9017
Country	:	US
Telephone Number	:	330-837-7809
Fax Number	:

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

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	04/23/2026

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Directions to “ KATELYN JOY BAKER ” Practice Location

Language	Start Address	Practice Location

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