Provider Demographics
NPI:1326129438
Name:BAKER, SARAH LEE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:LEE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LEE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1006 BIRCHMONT DR NE
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3905
Mailing Address - Country:US
Mailing Address - Phone:218-751-8601
Mailing Address - Fax:
Practice Address - Street 1:1006 BIRCHMONT DR NE
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3905
Practice Address - Country:US
Practice Address - Phone:218-751-8601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4798101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health