Provider Demographics
NPI:1851846877
Name:BAKER, SUZANNE (MED)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
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 1:29959 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1734
Mailing Address - Country:US
Mailing Address - Phone:614-670-3562
Mailing Address - Fax:
Practice Address - Street 1:5018 STATE ROUTE 183 NE
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:OH
Practice Address - Zip Code:44643-8325
Practice Address - Country:US
Practice Address - Phone:330-866-9225
Practice Address - Fax:330-866-2572
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3060628103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool