Provider Demographics
NPI:1649237520
Name:BAKER, NANCY L (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N MAIN ST STE 609
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-4953
Mailing Address - Country:US
Mailing Address - Phone:920-410-1504
Mailing Address - Fax:920-233-5644
Practice Address - Street 1:404 N MAIN ST STE 609
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4953
Practice Address - Country:US
Practice Address - Phone:920-858-2766
Practice Address - Fax:920-233-5644
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2272-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39671000Medicaid