Provider Demographics
NPI:1578984423
Name:BAKER, WINIFRED
Entity Type:Individual
Prefix:MS
First Name:WINIFRED
Middle Name:
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 1:6800 E LAKE MEAD BLVD UNIT 2095
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-1143
Mailing Address - Country:US
Mailing Address - Phone:702-272-1858
Mailing Address - Fax:
Practice Address - Street 1:6800 E LAKE MEAD BLVD UNIT 2095
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-1143
Practice Address - Country:US
Practice Address - Phone:702-272-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000XBEHAVIORAL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst