Provider Demographics
NPI:1073974796
Name:BAKER, CHANNON M (CHW, PSS)
Entity Type:Individual
Prefix:MRS
First Name:CHANNON
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:CHW, PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 WESTGATE BLDG #2
Mailing Address - Street 2:PENDLETON CREEK CRISIS STABILIZATION UNIT
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801
Mailing Address - Country:US
Mailing Address - Phone:541-240-8030
Mailing Address - Fax:541-429-8737
Practice Address - Street 1:7525 WESTGATE BLDG #2
Practice Address - Street 2:PENDLETON CREEK CRISIS STABILIZATION UNIT
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-240-8030
Practice Address - Fax:541-429-8737
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist