Healthcare Provider Details

I. General information

NPI: 1669035010
Provider Name (Legal Business Name): ARISA WONGJODSRI BAKER PSY.D, LEP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ARISA WONGJODSRI PSY.D, LEP, BCBA

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 TRUMPET DR
REDDING CA
96003-6807
US

IV. Provider business mailing address

1744 TRUMPET DR
REDDING CA
96003-6807
US

V. Phone/Fax

Practice location:
  • Phone: 626-940-8143
  • Fax:
Mailing address:
  • Phone: 626-940-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3557
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-19317
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: