Provider Demographics
NPI:1598464463
Name:BAKKER, CHRISTINA (CADC II, QMHA II)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BAKKER
Suffix:
Gender:
Credentials:CADC II, QMHA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0516
Mailing Address - Country:US
Mailing Address - Phone:541-475-4822
Mailing Address - Fax:
Practice Address - Street 1:15405 SW 116TH AVE STE 124
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:OR
Practice Address - Zip Code:97224-4103
Practice Address - Country:US
Practice Address - Phone:617-921-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-QMHA-II-000342101YM0800X
OR23-CRM-II-0136175T00000X
OR24-10-20488101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR210848Medicaid