Provider Demographics
NPI:1851967699
Name:BAXTER, ASPEN SAGE
Entity Type:Individual
Prefix:MISS
First Name:ASPEN
Middle Name:SAGE
Last Name:BAXTER
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 1:29710 COWBOY DAYS RD
Mailing Address - Street 2:
Mailing Address - City:WANETTE
Mailing Address - State:OK
Mailing Address - Zip Code:74878-8203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:209-756-6455
Practice Address - Street 1:29710 COWBOY DAYS RD
Practice Address - Street 2:
Practice Address - City:WANETTE
Practice Address - State:OK
Practice Address - Zip Code:74878-8203
Practice Address - Country:US
Practice Address - Phone:209-756-6455
Practice Address - Fax:209-756-6455
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician