Provider Demographics
NPI:1265002109
Name:BAKER, KATHRYN ARIELLE VLIETSTRA (AUD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ARIELLE VLIETSTRA
Last Name:BAKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ARIELLE
Other - Last Name:VLIETSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 WINDHAM RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4822
Mailing Address - Country:US
Mailing Address - Phone:920-946-8365
Mailing Address - Fax:
Practice Address - Street 1:4772 EUCLID RD STE C
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3800
Practice Address - Country:US
Practice Address - Phone:757-272-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001837231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist