Provider Demographics
NPI:1871760660
Name:BAKER, SHALAN KATHLEEN (BCBA)
Entity type:Individual
Prefix:
First Name:SHALAN
Middle Name:KATHLEEN
Last Name:BAKER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3449 W STATE ROAD 16
Mailing Address - Street 2:
Mailing Address - City:ROYAL CENTER
Mailing Address - State:IN
Mailing Address - Zip Code:46978-9052
Mailing Address - Country:US
Mailing Address - Phone:574-727-1026
Mailing Address - Fax:
Practice Address - Street 1:3449 W STATE ROAD 16
Practice Address - Street 2:
Practice Address - City:ROYAL CENTER
Practice Address - State:IN
Practice Address - Zip Code:46978-9052
Practice Address - Country:US
Practice Address - Phone:574-727-1026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-32968103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst