Provider Demographics
NPI:1992098990
Name:BAKER, MARY BIRKELAND (MS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BIRKELAND
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N 1ST AVE
Mailing Address - Street 2:MS#70
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3001
Mailing Address - Country:US
Mailing Address - Phone:503-846-4557
Mailing Address - Fax:503-846-4560
Practice Address - Street 1:155 N 1ST AVE
Practice Address - Street 2:MS#70
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-3001
Practice Address - Country:US
Practice Address - Phone:503-846-4557
Practice Address - Fax:503-846-4560
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0287101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional