Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 0983 | MN |
N | 103T00000X | Psychologist | 0983 | MN |
NPI | 1003879289 |
---|---|
Provider Name | Jacquelyn H Baker |
First Address | Minneapolis, MN 55440-0043 |
Second Address | Plymouth, MN 55441-2649 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OTH000 | (02) |