Active NPI
Bailey Jane Bakken
- Behavior Technician
- Campbell, CA
National Provider Identifier
1780171991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 17-43052
- Practice address
- 1500 E Hamilton Ave Ste 105
Campbell, CA 95008-0834 - Phone
- (408) 772-3775
- NPI assigned
- Apr 13, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 17-43052 | CA | Primary |
Addresses
Primary practice location
1500 E Hamilton Ave Ste 105
Campbell, CA 95008-0834
Mailing address
1042 Foxchase Dr Apt 339
San Jose, CA 95123-1139
Phone (408) 412-2427
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17-43052 | CA | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced ABA Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Early Intervention Provider Agency
- Campbell, CA
- NPI 1174863518
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625529600000",
"number": "1780171991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1042 FOXCHASE DR APT 339",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951231139",
"telephone_number": "408-412-2427"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 E HAMILTON AVE STE 105",
"city": "CAMPBELL",
"state": "CA",
"postal_code": "950080834",
"telephone_number": "408-772-3775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAKKEN",
"first_name": "BAILEY",
"middle_name": "JANE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-13",
"last_updated": "2021-07-06",
"certification_date": "2021-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "17-43052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Campbell, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.