Provider Demographics
NPI:1851351142
Name:BAKER, LINDA LU (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LU
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:LUCILLE
Other - Last Name:RUBRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:801 HAZEN STREET SUITE C
Mailing Address - Street 2:PO BOX 249
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-0249
Mailing Address - Country:US
Mailing Address - Phone:269-657-5574
Mailing Address - Fax:269-657-3474
Practice Address - Street 1:1007 E WELLS STREET
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-9612
Practice Address - Country:US
Practice Address - Phone:269-637-5297
Practice Address - Fax:269-637-9238
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801020383104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH06346005Medicare ID - Type Unspecified