Provider Demographics
NPI:1831264852
Name:BAKER, BILL D (MSW)
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:D
Last Name:BAKER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW PA
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 4891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID00010017691OtherREGENCE BLUE SHIELD OF ID
ID0008075Medicaid
IDL4900OtherBLUE CROSS OF IDAHO
IDL4900OtherBLUE CROSS OF IDAHO