Provider Demographics
NPI:1689187221
Name:BAKER, KIMBERLY A (CP61009456)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:BAKER
Suffix:
Gender:
Credentials:CP61009456
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 WAHKIAKUM PL
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-9534
Mailing Address - Country:US
Mailing Address - Phone:360-333-0279
Mailing Address - Fax:
Practice Address - Street 1:8212 S MARCH POINT RD
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-8684
Practice Address - Country:US
Practice Address - Phone:360-588-2800
Practice Address - Fax:360-588-2800
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61009456101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP61009456OtherDEPARTMENT OF HEALTH