Provider Demographics
NPI:1750793626
Name:BAKER, KAISA MIRIAM (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAISA
Middle Name:MIRIAM
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213-1296
Mailing Address - Country:US
Mailing Address - Phone:575-621-4820
Mailing Address - Fax:
Practice Address - Street 1:1204 LINDEN ST
Practice Address - Street 2:
Practice Address - City:DALLAS CENTER
Practice Address - State:IA
Practice Address - Zip Code:50063-1052
Practice Address - Country:US
Practice Address - Phone:575-621-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2356235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist