Provider Demographics
NPI:1902526288
Name:BAESEMAN, CHEYENNE SHANEE
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:SHANEE
Last Name:BAESEMAN
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 1:2005 24TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3011
Mailing Address - Country:US
Mailing Address - Phone:602-214-3989
Mailing Address - Fax:
Practice Address - Street 1:902 PINE ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1403
Practice Address - Country:US
Practice Address - Phone:602-214-3989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)