Provider Demographics
NPI:1962796250
Name:BAKER, SCOTT WESLEY (LAC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:WESLEY
Last Name:BAKER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-5531
Mailing Address - Country:US
Mailing Address - Phone:206-697-6195
Mailing Address - Fax:
Practice Address - Street 1:20307 VIKING AVE NW
Practice Address - Street 2:STE 202
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8321
Practice Address - Country:US
Practice Address - Phone:360-379-6798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60137267171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist