Provider Demographics
NPI:1891944450
Name:BAKER, MARILYN L (MS, RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 REGENT DR
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-2084
Mailing Address - Country:US
Mailing Address - Phone:847-566-0791
Mailing Address - Fax:
Practice Address - Street 1:777 PARK AVE W
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2433
Practice Address - Country:US
Practice Address - Phone:847-926-5032
Practice Address - Fax:847-480-2705
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.000692133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic