Individual
STACIE RENAE BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1545 REDWOOD PL, TAHLEQUAH, OK 74464-6050
(918) 456-6027
Mailing address
1545 REDWOOD PL, TAHLEQUAH, OK 74464-6050
(918) 456-6027
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
01/15/2012
Last updated
01/15/2012
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