Provider Demographics
NPI:1619235926
Name:BAKER, DAWN (PLMHP, NCC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:PLMHP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10748 VIRGINIA PLZ
Mailing Address - Street 2:STE 107
Mailing Address - City:LAVISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128
Mailing Address - Country:US
Mailing Address - Phone:402-933-4411
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST
Practice Address - Street 2:STE 514
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2939
Practice Address - Country:US
Practice Address - Phone:402-614-8444
Practice Address - Fax:402-614-8443
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
NE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker