Provider Demographics
NPI:1275682163
Name:BAKER, SHARON K (CDPT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:K
Last Name:BAKER
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:K
Other - Last Name:MASSENGALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301
Mailing Address - Country:US
Mailing Address - Phone:509-547-2204
Mailing Address - Fax:509-542-8836
Practice Address - Street 1:720 W COURT ST
Practice Address - Street 2:#8
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:509-545-6506
Practice Address - Fax:509-546-0520
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00043550101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)