Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 180.009174 | IL |
NPI | 1003228578 |
---|---|
Provider Name | Ms. Jennifer Ashley Baker I |
First Address | Chicago, IL 60612-3610 |
Second Address | Chicago, IL 60640-1472 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2014 |
Last Update Date | 04/04/2016 |