Provider Demographics
NPI:1053521328
Name:BAKER, DEBORAH ANN (MA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA
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 935
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-0101
Mailing Address - Country:US
Mailing Address - Phone:503-697-3483
Mailing Address - Fax:503-697-0704
Practice Address - Street 1:543 3RD ST
Practice Address - Street 2:SUITE C-12
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3067
Practice Address - Country:US
Practice Address - Phone:503-697-3484
Practice Address - Fax:503-697-0704
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0168101YP2500X
ORT0103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist