Provider Demographics
NPI:1497398838
Name:BAKER, AMANDA LEA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEA
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 1:3314 SE NAVIGATION LN APT 206
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2887
Mailing Address - Country:US
Mailing Address - Phone:360-843-9707
Mailing Address - Fax:
Practice Address - Street 1:19351 8TH AVE NE STE 141
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7087
Practice Address - Country:US
Practice Address - Phone:360-598-3929
Practice Address - Fax:360-598-4114
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)