Healthcare Provider Details

I. General information

NPI: 1912462417
Provider Name (Legal Business Name): SUMMER BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 HELENA LN
KAPAA HI
96746-9100
US

IV. Provider business mailing address

PO BOX 326
ANAHOLA HI
96703-0326
US

V. Phone/Fax

Practice location:
  • Phone: 808-634-2407
  • Fax:
Mailing address:
  • Phone: 808-634-2407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18-CRM-374
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: