Provider Demographics
NPI:1477537967
Name:BAKER, ANNE M (AUD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:ANNE
Other - Middle Name:M
Other - Last Name:MOLITERNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1032 BOARDMAN-CANFIELD RD.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44515
Mailing Address - Country:US
Mailing Address - Phone:330-726-3339
Mailing Address - Fax:330-726-0482
Practice Address - Street 1:980 W STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2017
Practice Address - Country:US
Practice Address - Phone:330-337-3332
Practice Address - Fax:330-337-9332
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01065231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000233661OtherANTHEM
OH000000233661OtherANTHEM BCBS
OH2915199Medicaid
OH2097985Medicaid
AU9300001Medicare ID - Type Unspecified
OH000000233661OtherANTHEM
OHM04090121Medicare PIN