Healthcare Provider Details

I. General information

NPI: 1093933202
Provider Name (Legal Business Name): AMANDA A BAKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

7750 N UNION BLVD SUITE 202
COLORADO SPRINGS CO
80920-4051
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-5781
  • Fax: 719-776-2313
Mailing address:
  • Phone: 719-776-8482
  • Fax: 719-776-8568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number666
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: