Provider Demographics
NPI:1609649565
Name:BAKER, CHARISE K
Entity Type:Individual
Prefix:
First Name:CHARISE
Middle Name:K
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:BIG BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49808-0111
Mailing Address - Country:US
Mailing Address - Phone:906-360-8529
Mailing Address - Fax:
Practice Address - Street 1:106 COLES DR
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4010
Practice Address - Country:US
Practice Address - Phone:906-360-8529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7153000025235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist