Provider Demographics
NPI:1700937224
Name:BAKER, LAURA DEHAVEN (PHD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DEHAVEN
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:19120 RIDGE ROAD SW
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-0443
Mailing Address - Country:US
Mailing Address - Phone:206-795-1194
Mailing Address - Fax:
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:VAPSHCS, GRECC-182A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-762-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist