Provider Demographics
NPI:1891106159
Name:BAKER, PAMELA (MAED CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:MAED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5890 LEFT FORK MACES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:VIPER
Mailing Address - State:KY
Mailing Address - Zip Code:41774-8458
Mailing Address - Country:US
Mailing Address - Phone:606-439-2520
Mailing Address - Fax:
Practice Address - Street 1:5890 LEFT FORK MACES CREEK RD
Practice Address - Street 2:
Practice Address - City:VIPER
Practice Address - State:KY
Practice Address - Zip Code:41774-8458
Practice Address - Country:US
Practice Address - Phone:606-439-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist