Provider Demographics
NPI:1285855734
Name:BAKER, BONNIE (CDP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13016 138TH AVENUE KP N
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98329-5301
Mailing Address - Country:US
Mailing Address - Phone:253-535-3919
Mailing Address - Fax:
Practice Address - Street 1:12202 PACIFIC AVE S STE D
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:WA
Practice Address - Zip Code:98444-5157
Practice Address - Country:US
Practice Address - Phone:253-535-3919
Practice Address - Fax:253-535-4155
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00050628101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)