Individual
GWENDOLYN BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16640 W RIM ROCK ST, SURPRISE, AZ 85388-1193
(623) 594-9924
Mailing address
16640 W RIM ROCK ST, SURPRISE, AZ 85388-1193
(623) 594-9924
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
1825
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AHCCCS
823759
AZ
Enumeration date
11/20/2006
Last updated
07/08/2007
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