Provider Demographics
NPI:1831210277
Name:BILL BAKER MSW PA
Entity type:Organization
Organization Name:BILL BAKER MSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:208-880-4160
Mailing Address - Street 1:1219 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4222
Mailing Address - Country:US
Mailing Address - Phone:208-880-4160
Mailing Address - Fax:208-461-3303
Practice Address - Street 1:1219 4TH ST S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4222
Practice Address - Country:US
Practice Address - Phone:208-880-4160
Practice Address - Fax:208-461-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 4891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1379116Medicare ID - Type Unspecified