Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | IL |
NPI | 1003000662 |
---|---|
Provider Name | Kathleen Ann Baker |
First Address | Elk Grove Village, IL 60007-3217 |
Second Address | Elk Grove Village, IL 60007-3217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 28/08/2007 |