Provider Demographics
NPI:1013007442
Name:BAKER, TRUDY A (AUD)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:1229 E SEMINOLE ST
Practice Address - Street 2:SUITE 530
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2227
Practice Address - Country:US
Practice Address - Phone:417-820-5750
Practice Address - Fax:417-820-5066
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00618231H00000X
MO000792237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR177751720Medicaid
MO336726005Medicaid
MO336726013Medicaid
MO132300039Medicare PIN
MO132680032Medicare PIN