Provider Demographics
NPI:1114686268
Name:BAKER, KRIS ANNE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRIS
Middle Name:ANNE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:ANNE
Other - Last Name:KILLAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:329 FOSSHOLM ST NE APT C3
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1556
Mailing Address - Country:US
Mailing Address - Phone:503-545-9414
Mailing Address - Fax:
Practice Address - Street 1:329 FOSSHOLM ST NE APT C3
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1556
Practice Address - Country:US
Practice Address - Phone:503-545-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X, 101Y00000X
OR106591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor