Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | OU1020483 | OH |
NPI | 1003211905 |
---|---|
Provider Name | Ms. Tessy Lynn Baker |
First Address | Peebles, OH 45660-9755 |
Second Address | Peebles, OH 45660-9755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2014 |
Last Update Date | 04/11/2014 |