Provider Demographics
NPI:1528392073
Name:BAKER, SHAWNRY J
Entity Type:Individual
Prefix:
First Name:SHAWNRY
Middle Name:J
Last Name:BAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9115 JENNY COOK CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-2271
Mailing Address - Country:US
Mailing Address - Phone:404-983-4332
Mailing Address - Fax:
Practice Address - Street 1:9041 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 126
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4621
Practice Address - Country:US
Practice Address - Phone:865-693-5622
Practice Address - Fax:865-769-0801
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist