Provider Demographics
NPI:1750510004
Name:BAKER, MARILYN RUTH (MED)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:RUTH
Last Name:BAKER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 GLENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41014-1541
Mailing Address - Country:US
Mailing Address - Phone:859-620-7406
Mailing Address - Fax:859-291-0139
Practice Address - Street 1:425 GARRAD STREET
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011
Practice Address - Country:US
Practice Address - Phone:859-620-7406
Practice Address - Fax:859-291-0139
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0537235Z00000X
OH3225235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist