Provider Demographics
NPI:1841268638
Name:BAKER, ROBIN MATLOCK (AUD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:MATLOCK
Last Name:BAKER
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 1:507 NW ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3504
Mailing Address - Country:US
Mailing Address - Phone:931-393-4332
Mailing Address - Fax:931-393-2304
Practice Address - Street 1:507 NW ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3504
Practice Address - Country:US
Practice Address - Phone:931-393-4332
Practice Address - Fax:931-393-2304
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1302231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3194373Medicaid
TN4198490OtherBCBS
TN4198490OtherBCBS