Provider Demographics
NPI:1598018517
Name:BAKER, CHANDA REISHA (MS, CFY-SLP)
Entity Type:Individual
Prefix:
First Name:CHANDA
Middle Name:REISHA
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 SOUTH 9TH ST.
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 SOUTH 11TH ST.
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401
Practice Address - Country:US
Practice Address - Phone:575-461-4344
Practice Address - Fax:575-461-8033
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-5133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist