Provider Demographics
NPI:1013057223
Name:BAXTER, JANE HILDRETH (AUD)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:HILDRETH
Last Name:BAXTER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:STE 1
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6509
Mailing Address - Country:US
Mailing Address - Phone:650-854-1980
Mailing Address - Fax:650-854-1987
Practice Address - Street 1:3555 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:STE 1
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6509
Practice Address - Country:US
Practice Address - Phone:650-854-1980
Practice Address - Fax:650-854-1987
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 737231H00000X
CAHA 2199237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0023741Medicaid
CAGR0023741Medicaid