Provider Demographics
NPI:1033846464
Name:BAKER, CARLY JEAN (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:JEAN
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 MOOSE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WOODSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43793-9161
Mailing Address - Country:US
Mailing Address - Phone:740-213-0650
Mailing Address - Fax:
Practice Address - Street 1:2333B STATE ROUTE 821
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-5362
Practice Address - Country:US
Practice Address - Phone:740-373-6669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20221983-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist