Basic Information
| Provider Information | |||||||||
| NPI: | 1013007442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | TRUDY | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2580 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658012580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178294620 | ||||||||
| FaxNumber: | 4178294316 | ||||||||
| Practice Location | |||||||||
| Address1: | 1229 E SEMINOLE ST | ||||||||
| Address2: | SUITE 530 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658042227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178205750 | ||||||||
| FaxNumber: | 4178205066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2006 | ||||||||
| LastUpdateDate: | 08/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 00618 | MO | Y | Speech, Language and Hearing Service Providers | Audiologist | 237700000X | 000792 | MO | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 177751720 | 05 | AR | MEDICAID | 336726005 | 05 | MO | MEDICAID | 336726013 | 05 | MO | MEDICAID |