MEDICARE: DR. RITA M. BAKER PH.D.

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	103G00000X	Clinical Neuropsychologist	1165	CO

General Provider Information

NPI Number	:	1477671626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RITA M. BAKER PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 616
Second Line	:
City	:	MORRISON
State	:	CO
Zip	:	80465-0616
Country	:	US
Telephone Number	:	303-973-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	9200 W CROSS DR
Second Line	:	SUITE 405
City	:	LAKEWOOD
State	:	CO
Zip	:	80123-2239
Country	:	US
Telephone Number	:	303-973-7300
Fax Number	:	303-697-6333

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	01/10/2014

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