Provider Demographics
NPI:1568791283
Name:BAKER, CHERYL A (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:A
Last Name:BAKER
Suffix:
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:PO BOX 548
Mailing Address - Street 2:204 SOUTH STREET
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-0548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10108 W OVERLAND RD # A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1428
Practice Address - Country:US
Practice Address - Phone:208-761-5323
Practice Address - Fax:208-375-7251
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043-068761164W00000X
IDLCPC-6499101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse