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NPI Code Detail

MEDICARE: MICAELA JAYNE BAKER

MEDICARE: MICAELA JAYNE BAKER
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1851934764
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICAELA JAYNE BAKER
Provider Business Mailing Address
First Line : 307 W COTA ST
Second Line :
City : SHELTON
State : WA
Zip : 98584-2265
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 307 W COTA ST
Second Line :
City : SHELTON
State : WA
Zip : 98584-2265
Country : US
Telephone Number : 503-348-3767
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2019
Last Update Date : 10/23/2019

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Directions to “ MICAELA JAYNE BAKER ” Practice Location

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