Provider Demographics
NPI:1083810097
Name:BAKLEY, LOUISE P (MED CCC)
Entity Type:Individual
Prefix:MR
First Name:LOUISE
Middle Name:P
Last Name:BAKLEY
Suffix:
Gender:F
Credentials:MED CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOFFSES DRIVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843
Mailing Address - Country:US
Mailing Address - Phone:207-236-8617
Mailing Address - Fax:
Practice Address - Street 1:69 ELM STREET
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843
Practice Address - Country:US
Practice Address - Phone:207-975-3541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist