Provider Demographics
NPI:1386780013
Name:BAKER, PHILLIP WILSON (EDD PSYCHOLOGY)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:WILSON
Last Name:BAKER
Suffix:
Gender:M
Credentials:EDD PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4325 LAUREL ST STE 215
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5365
Mailing Address - Country:US
Mailing Address - Phone:907-562-2392
Mailing Address - Fax:907-562-4901
Practice Address - Street 1:4325 LAUREL ST STE 215
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5365
Practice Address - Country:US
Practice Address - Phone:907-562-2392
Practice Address - Fax:907-562-4901
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AKAA338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical