Provider Demographics
NPI:1295158558
Name:BAKER, ALEXIS (MT-BC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 KENTHORPE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2101
Mailing Address - Country:US
Mailing Address - Phone:360-610-9500
Mailing Address - Fax:
Practice Address - Street 1:15422 BANGY RD APT 10
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3127
Practice Address - Country:US
Practice Address - Phone:360-610-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMT-T-10174270225A00000X
OR225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR225A00000XMedicaid