Provider Demographics
NPI:1578886917
Name:BAKER, SUE N (CLINICIAN)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:N
Last Name:BAKER
Suffix:
Gender:F
Credentials:CLINICIAN
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:N
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:9 N WATER ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-2819
Mailing Address - Country:US
Mailing Address - Phone:918-224-9307
Mailing Address - Fax:
Practice Address - Street 1:9 N WATER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-2819
Practice Address - Country:US
Practice Address - Phone:918-224-9307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK300522336OtherCREEK NATION CLINICS AND HOSPITAL