Provider Demographics
NPI:1164861183
Name:BAKER, DAVID A (MS SLP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:BAKER
Suffix:
Gender:M
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1505
Mailing Address - Country:US
Mailing Address - Phone:570-574-6730
Mailing Address - Fax:
Practice Address - Street 1:390 MILLER ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1505
Practice Address - Country:US
Practice Address - Phone:570-574-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program