Provider Demographics
NPI:1124091210
Name:BAKER, GAIL E (LCSW)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:E
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 AVENUE H APT 503
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6433
Mailing Address - Country:US
Mailing Address - Phone:406-461-7267
Mailing Address - Fax:
Practice Address - Street 1:503 AVENUE H APT 503
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6433
Practice Address - Country:US
Practice Address - Phone:406-461-7267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT581 LCSW1041C0700X
IDLCSW-315041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000070495OtherBLUE CROSS/SHIELD OF MONT
MTP00692103 C01340OtherRAILROAD MEDICARE PROVIDER NUMBER
MT0000070495OtherBLUE CROSS/SHIELD OF MONT