Healthcare Provider Details

I. General information

NPI: 1326966169
Provider Name (Legal Business Name): CAROL JEAN BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 W PARK PL STE 105
COEUR D ALENE ID
83814-2787
US

IV. Provider business mailing address

PO BOX 727
HAYDEN ID
83835-0727
US

V. Phone/Fax

Practice location:
  • Phone: 208-771-7013
  • Fax: 208-719-7952
Mailing address:
  • Phone: 208-771-7013
  • Fax: 208-719-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1971797
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: