1265568257 NPI number — MS. WENDY LEE BAKER MSW, LICSW

Table of content: MS. WENDY LEE BAKER MSW, LICSW (NPI 1265568257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265568257 NPI number — MS. WENDY LEE BAKER MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
WENDY
Provider Middle Name:
LEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265568257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
348 PRIOR AVE N
Provider Second Line Business Mailing Address:
SUITE #205
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55104-5187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-646-1488
Provider Business Mailing Address Fax Number:
651-646-2285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
348 PRIOR AVE N
Provider Second Line Business Practice Location Address:
SUITE #205
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55104-5187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-646-1488
Provider Business Practice Location Address Fax Number:
651-646-2285
Provider Enumeration Date:
02/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  10703 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6271180 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 88G66FA . This is a "BCBS GROUP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 88G76BA1 . This is a "BCBS INDIV." identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".