Provider Demographics
NPI:1326486879
Name:BAKER, NICOLE RENEE-HAUSER (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:RENEE-HAUSER
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 HIGHWAY 10 STE 102
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-5204
Mailing Address - Country:US
Mailing Address - Phone:320-980-5088
Mailing Address - Fax:763-441-3117
Practice Address - Street 1:907 MAIN ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1508
Practice Address - Country:US
Practice Address - Phone:320-980-5088
Practice Address - Fax:763-441-3117
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3828106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist