Provider Demographics
NPI:1225561582
Name:BAKER, MOLLIE BRYNNE (LCSW)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:BRYNNE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:BRYNNE
Other - Last Name:DUGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:327 WILBUR CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:WILBUR
Mailing Address - State:OR
Mailing Address - Zip Code:97494-0201
Mailing Address - Country:US
Mailing Address - Phone:267-619-4973
Mailing Address - Fax:
Practice Address - Street 1:327 WILBUR CEMETERY RD
Practice Address - Street 2:
Practice Address - City:WILBUR
Practice Address - State:OR
Practice Address - Zip Code:97494-0201
Practice Address - Country:US
Practice Address - Phone:267-619-4973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131964104100000X
1041C0700X
ORL127451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker