Provider Demographics
NPI:1689305823
Name:BAXTER, RAISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:RAISSA
Middle Name:
Last Name:BAXTER
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 1:1658 S IL ROUTE 2
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-9514
Mailing Address - Country:US
Mailing Address - Phone:815-732-2499
Mailing Address - Fax:815-732-6077
Practice Address - Street 1:1658 S IL ROUTE 2
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-9514
Practice Address - Country:US
Practice Address - Phone:815-732-2499
Practice Address - Fax:815-732-6077
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490245791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical