Provider Demographics
NPI:1144180134
Name:REYNOLDS, MIRIAM ROSE BAKER (PHD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:ROSE BAKER
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 NW WALL ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2608
Mailing Address - Country:US
Mailing Address - Phone:541-355-6906
Mailing Address - Fax:541-355-1510
Practice Address - Street 1:520 NW WALL ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2608
Practice Address - Country:US
Practice Address - Phone:541-355-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-13
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool