Provider Demographics
NPI:1992258941
Name:BAKER, LESLIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4823
Mailing Address - Country:US
Mailing Address - Phone:360-209-8255
Mailing Address - Fax:844-621-7037
Practice Address - Street 1:1229 CORNWALL AVE STE 302
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5023
Practice Address - Country:US
Practice Address - Phone:360-209-8255
Practice Address - Fax:844-621-7037
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60668992101Y00000X
WAPY60723665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor