Basic Information
| Provider Information | |||||||||
| NPI: | 1548917578 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | SHELBY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14209 SPRINGWATER DR | ||||||||
| Address2: | |||||||||
| City: | MATTHEWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281056409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045822259 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5516 FENWAY DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282733976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047850560 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2022 | ||||||||
| LastUpdateDate: | 04/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 15312 | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.