Provider Demographics
NPI:1992041925
Name:BAKER, REBECCA LYNN (LAC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:BAKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4111 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CO
Mailing Address - Zip Code:80118-8930
Mailing Address - Country:US
Mailing Address - Phone:720-445-6292
Mailing Address - Fax:
Practice Address - Street 1:821 PARK ST STE A
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3135
Practice Address - Country:US
Practice Address - Phone:720-445-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0001855171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist