Provider Demographics
NPI:1891215141
Name:BAKER, CAROLYN MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5505
Mailing Address - Country:US
Mailing Address - Phone:740-354-7761
Mailing Address - Fax:
Practice Address - Street 1:522 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5505
Practice Address - Country:US
Practice Address - Phone:740-354-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.6573235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist