Provider Demographics
NPI:1881199339
Name:BAXTER, STORMIE S (M ED)
Entity Type:Individual
Prefix:
First Name:STORMIE
Middle Name:S
Last Name:BAXTER
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W GRANGEVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-2861
Mailing Address - Country:US
Mailing Address - Phone:720-642-0459
Mailing Address - Fax:
Practice Address - Street 1:515 W GRANGEVILLE BLVD
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2861
Practice Address - Country:US
Practice Address - Phone:720-642-0459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO53459405300000X
UT22200585405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional