Provider Demographics
NPI:1710435748
Name:BAKER, KARI A (MA, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KARI
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 SW POMONA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7442
Mailing Address - Country:US
Mailing Address - Phone:503-244-6051
Mailing Address - Fax:
Practice Address - Street 1:18765 SW BOONES FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8496
Practice Address - Country:US
Practice Address - Phone:503-612-1000
Practice Address - Fax:503-612-1090
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health