Provider Demographics
NPI:1346585163
Name:BAKER, KELLY ELIZABETH (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ELIZABETH
Last Name:BAKER
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11300 ROOSEVELT WAY NE STE 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6243
Mailing Address - Country:US
Mailing Address - Phone:206-264-1111
Mailing Address - Fax:206-749-4100
Practice Address - Street 1:11300 ROOSEVELT WAY NE STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6243
Practice Address - Country:US
Practice Address - Phone:206-264-1111
Practice Address - Fax:206-749-4100
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60285882171100000X
WANT 60319049175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist