Healthcare Provider Details

I. General information

NPI: 1508016866
Provider Name (Legal Business Name): MELISSA DOREEN BAKER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10414 BEARDSLEE BLVD STE 100
BOTHELL WA
98011-3205
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-0658
  • Fax: 425-277-1566
Mailing address:
  • Phone: 425-227-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60060436
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: