Provider Demographics
NPI:1841588472
Name:BAKER, GRACE HARDWICK (LSW)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:HARDWICK
Last Name:BAKER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:HARDWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25221 MILES RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5474
Mailing Address - Country:US
Mailing Address - Phone:216-514-1600
Mailing Address - Fax:
Practice Address - Street 1:25221 MILES RD
Practice Address - Street 2:SUITE F
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5474
Practice Address - Country:US
Practice Address - Phone:216-514-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OHS.1201063104100000X
TN8385104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker