Provider Demographics
NPI:1306363395
Name:BAKNER, HEATHER (LAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BAKNER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 CHAPMAN LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1516
Mailing Address - Country:US
Mailing Address - Phone:541-646-4218
Mailing Address - Fax:
Practice Address - Street 1:1875 HIGHWAY 99 N STE 11
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9600
Practice Address - Country:US
Practice Address - Phone:541-482-2225
Practice Address - Fax:541-488-2962
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC183271171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty