Provider Demographics
NPI:1003976861
Name:BAKER, KURT DAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:DAYNE
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W MONTE VISTA AVE
Mailing Address - Street 2:DEPT OF PSYCHOLOGY, CAL STATE UNIVERSITY, STANISLAUS
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-0256
Mailing Address - Country:US
Mailing Address - Phone:209-664-6681
Mailing Address - Fax:
Practice Address - Street 1:4125 BANGS AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8713
Practice Address - Country:US
Practice Address - Phone:209-557-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20518103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical