Provider Demographics
NPI:1265570204
Name:BAKER, CHARLIEN K (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:
First Name:CHARLIEN
Middle Name:K
Last Name:BAKER
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1103
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85934-1103
Mailing Address - Country:US
Mailing Address - Phone:928-739-4322
Mailing Address - Fax:
Practice Address - Street 1:500 W OLD LINDEN RD
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-4608
Practice Address - Country:US
Practice Address - Phone:928-537-6033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34058262355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant