Provider Demographics
NPI:1588176663
Name:BAKER, KAYLYN RUTH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLYN
Middle Name:RUTH
Last Name:BAKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17612 COBALT AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4173
Mailing Address - Country:US
Mailing Address - Phone:580-275-9056
Mailing Address - Fax:
Practice Address - Street 1:3838 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2970
Practice Address - Country:US
Practice Address - Phone:405-702-9032
Practice Address - Fax:405-702-9031
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist