Provider Demographics
NPI:1760434401
Name:BAKER, CLAUDETTE T (LAC /HERBS(NCCAOM))
Entity Type:Individual
Prefix:MS
First Name:CLAUDETTE
Middle Name:T
Last Name:BAKER
Suffix:
Gender:F
Credentials:LAC /HERBS(NCCAOM)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1757 GLENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025
Mailing Address - Country:US
Mailing Address - Phone:847-998-8860
Mailing Address - Fax:847-998-8863
Practice Address - Street 1:1757 GLENVIEW RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:847-998-8860
Practice Address - Fax:847-998-8863
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000059171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist