Provider Demographics
NPI:1508300740
Name:BAKER, DANA LYNN (LCPC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2501 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-5720
Mailing Address - Country:US
Mailing Address - Phone:847-915-8654
Mailing Address - Fax:217-398-9077
Practice Address - Street 1:3015 VILLAGE OFFICE PL # B
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-7674
Practice Address - Country:US
Practice Address - Phone:217-239-6085
Practice Address - Fax:217-356-7964
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012562101YP2500X
IL180.012875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional