Provider Demographics
NPI:1821249400
Name:DOUGHERTY, BARBARA BAKER (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:BAKER
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1443
Mailing Address - Country:US
Mailing Address - Phone:610-296-9768
Mailing Address - Fax:
Practice Address - Street 1:850 OLD STATE RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1443
Practice Address - Country:US
Practice Address - Phone:610-296-9768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001196L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist