Provider Demographics
NPI:1174802193
Name:BAKER, CHELSEA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13720 N 88TH AVE
Mailing Address - Street 2:APT. 1064
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3728
Mailing Address - Country:US
Mailing Address - Phone:218-205-0991
Mailing Address - Fax:
Practice Address - Street 1:13720 N 88TH AVE
Practice Address - Street 2:APT. 1064
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3728
Practice Address - Country:US
Practice Address - Phone:218-205-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP7332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist