Provider Demographics
NPI:1477188647
Name:HEATHER BAKNER LAC
Entity type:Organization
Organization Name:HEATHER BAKNER LAC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LAC
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-646-4218
Mailing Address - Street 1:2975 CHAPMAN LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1516
Mailing Address - Country:US
Mailing Address - Phone:541-646-4218
Mailing Address - Fax:
Practice Address - Street 1:1875 HIGHWAY 99 N STE 11
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9600
Practice Address - Country:US
Practice Address - Phone:541-482-2225
Practice Address - Fax:541-488-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty