Provider Demographics
NPI:1003228578
Name:BAKER, JENNIFER ASHLEY I (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ASHLEY
Last Name:BAKER
Suffix:I
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 W WILCOX ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3610
Mailing Address - Country:US
Mailing Address - Phone:314-402-9720
Mailing Address - Fax:
Practice Address - Street 1:1122 W CATALPA AVE
Practice Address - Street 2:1E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1472
Practice Address - Country:US
Practice Address - Phone:312-857-8473
Practice Address - Fax:312-940-3842
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional