Provider Demographics
NPI:1255864559
Name:BAKER, NATALIE ESCOBAR
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:ESCOBAR
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:ESCOBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4245 KEY LIME BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1619
Mailing Address - Country:US
Mailing Address - Phone:561-809-8247
Mailing Address - Fax:
Practice Address - Street 1:4245 KEY LIME BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-1619
Practice Address - Country:US
Practice Address - Phone:561-809-8247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2021-08-11
Deactivation Date:2021-06-18
Deactivation Code:
Reactivation Date:2021-07-26
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
FLSZ10119235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist