Provider Demographics
NPI:1376205211
Name:BAKER, JULIA KATHLEEN
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:KATHLEEN
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10327 GRAND RIVER RD STE 401
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6501
Mailing Address - Country:US
Mailing Address - Phone:800-787-5118
Mailing Address - Fax:
Practice Address - Street 1:10327 GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6500
Practice Address - Country:US
Practice Address - Phone:800-787-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician