Provider Demographics
NPI:1285089078
Name:BAKER, HOLLY RAE (MBA, CMA)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:RAE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MBA, CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 29TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-1749
Mailing Address - Country:US
Mailing Address - Phone:360-448-9954
Mailing Address - Fax:
Practice Address - Street 1:607 29TH ST
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-1749
Practice Address - Country:US
Practice Address - Phone:360-448-9954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACM60349936171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator