Healthcare Provider Details

I. General information

NPI: 1679831754
Provider Name (Legal Business Name): JANET BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 HENDERSON ST STE C
GRASS VALLEY CA
95945-7374
US

IV. Provider business mailing address

440 HENDERSON ST STE C
GRASS VALLEY CA
95945-7374
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-9541
  • Fax: 530-273-1327
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRRW4231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: