Provider Demographics
NPI:1154081024
Name:BAKER, SHELBY MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:MARIE
Other - Last Name:WALDHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2905 WILSON AVE SW STE 252
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1206
Mailing Address - Country:US
Mailing Address - Phone:616-259-5387
Mailing Address - Fax:
Practice Address - Street 1:2905 WILSON AVE SW STE 252
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1206
Practice Address - Country:US
Practice Address - Phone:616-259-5387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011176901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical