Provider Demographics
NPI:1851736003
Name:BAKER, ESTELLE MARIE (MS, ,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ESTELLE
Middle Name:MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS, ,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3101
Mailing Address - Country:US
Mailing Address - Phone:307-332-2715
Mailing Address - Fax:307-332-2715
Practice Address - Street 1:307 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3101
Practice Address - Country:US
Practice Address - Phone:307-332-2715
Practice Address - Fax:307-332-2715
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-610235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist