Provider Demographics
NPI:1487968871
Name:BAKKER, CARISSA ELOISE (MA)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:ELOISE
Last Name:BAKKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4585 SW 185TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-1557
Mailing Address - Country:US
Mailing Address - Phone:503-758-9863
Mailing Address - Fax:503-848-2072
Practice Address - Street 1:4585 SW 185TH AVE
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97007-1557
Practice Address - Country:US
Practice Address - Phone:503-758-9863
Practice Address - Fax:503-848-2072
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health