Provider Demographics
NPI:1063939023
Name:BAKKE, NATALIE ANN
Entity type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:ANN
Last Name:BAKKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 INGER DR STE 103-B
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8669
Mailing Address - Country:US
Mailing Address - Phone:805-346-8185
Mailing Address - Fax:
Practice Address - Street 1:245 INGER DR STE 103-B
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8669
Practice Address - Country:US
Practice Address - Phone:805-346-8185
Practice Address - Fax:805-357-5902
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)