Basic Information
| Provider Information | |||||||||
| NPI: | 1235683111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKEWELL | ||||||||
| FirstName: | JORDANNE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 921 W AVENUE J | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935343443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619490131 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40005 10TH ST W | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612658627 | ||||||||
| FaxNumber: | 6612657936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2016 | ||||||||
| LastUpdateDate: | 08/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMF 93928 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 93928 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.