Provider Demographics
NPI:1124594932
Name:BAKER, KELSEY COGGINS (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:COGGINS
Last Name:BAKER
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WEBSTER RD LOT 463
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-4221
Mailing Address - Country:US
Mailing Address - Phone:334-303-3404
Mailing Address - Fax:
Practice Address - Street 1:643 WOODEN BRIDGE DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-7036
Practice Address - Country:US
Practice Address - Phone:334-524-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist