Provider Demographics
NPI:1962537563
Name:BAKER, MATHILDA KATHLEEN
Entity type:Individual
Prefix:MRS
First Name:MATHILDA
Middle Name:KATHLEEN
Last Name:BAKER
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 1:1400 CHESTNUT ST STE B
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-3773
Mailing Address - Country:US
Mailing Address - Phone:530-251-8457
Mailing Address - Fax:
Practice Address - Street 1:1400 CHESTNUT ST STE B
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-3773
Practice Address - Country:US
Practice Address - Phone:530-251-8457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)