Provider Demographics
NPI:1902939754
Name:BAKER, BONNIE S (PHD ACSW)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:S
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHD ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:WA
Mailing Address - Zip Code:99020-0037
Mailing Address - Country:US
Mailing Address - Phone:509-455-9888
Mailing Address - Fax:509-448-2057
Practice Address - Street 1:1528 W AUGUSTA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4254
Practice Address - Country:US
Practice Address - Phone:509-455-9888
Practice Address - Fax:509-448-2057
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006792101YM0800X
WALW000054821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
G319000180Medicare ID - Type Unspecified