Provider Demographics
NPI:1891461695
Name:BAKER, ABIGAIL ELIZABETH
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ELIZABETH
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 N COLFAX ST
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61010-1438
Mailing Address - Country:US
Mailing Address - Phone:815-234-2722
Mailing Address - Fax:
Practice Address - Street 1:1450 20TH ST
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-1076
Practice Address - Country:US
Practice Address - Phone:815-562-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.006517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist