Provider Demographics
NPI:1457667826
Name:BAKER, PAMELA DENISE (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:DENISE
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27255 N FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-9117
Mailing Address - Country:US
Mailing Address - Phone:847-487-9455
Mailing Address - Fax:847-487-9037
Practice Address - Street 1:27255 N FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-9117
Practice Address - Country:US
Practice Address - Phone:847-487-9455
Practice Address - Fax:847-487-9037
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005778101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional