MEDICARE: MS. ALTA ELIZABETH BAKER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L0741	OR

General Provider Information

NPI Number	:	1265585970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALTA ELIZABETH BAKER LCSW

Provider Business Mailing Address
First Line	:	16087 SE EVELYN ST
Second Line	:
City	:	CLACKAMAS
State	:	OR
Zip	:	97015-9519
Country	:	US
Telephone Number	:	503-655-3212
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 WILLAMETTE FALLS DR STE 260
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-4654
Country	:	US
Telephone Number	:	503-656-6920
Fax Number	:	503-657-3696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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