Healthcare Provider Details

I. General information

NPI: 1851992705
Provider Name (Legal Business Name): HEATHERANNE BAKER-OLDFIELD PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 E CAMELBACK RD STE 700
PHOENIX AZ
85016
US

IV. Provider business mailing address

4150 N 9TH ST APT 303
PHOENIX AZ
85014-4775
US

V. Phone/Fax

Practice location:
  • Phone: 480-249-9703
  • Fax:
Mailing address:
  • Phone: 480-249-9703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: