Provider Demographics
NPI:1548427438
Name:BAYLOR, CHARLES MORGAN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MORGAN
Last Name:BAYLOR
Suffix:
Gender:M
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-2353
Mailing Address - Country:US
Mailing Address - Phone:570-654-8246
Mailing Address - Fax:
Practice Address - Street 1:316 WARREN ST
Practice Address - Street 2:
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-2353
Practice Address - Country:US
Practice Address - Phone:570-654-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002638L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist