Provider Demographics
NPI:1740243237
Name:BAKER, CATHERINE I (LMSW LSCSW)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:I
Last Name:BAKER
Suffix:
Gender:F
Credentials:LMSW LSCSW
Other - Prefix:MRS
Other - First Name:CATHY
Other - Middle Name:I
Other - Last Name:DUBOIS BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW LSCSW
Mailing Address - Street 1:2618 TAMARISK ST
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-4236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 N BALTIMORE
Practice Address - Street 2:STE 1
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037
Practice Address - Country:US
Practice Address - Phone:316-788-2200
Practice Address - Fax:316-788-1514
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW19091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4748OtherPREFERRED HEALTH
KS6249585OtherUBH
KS69290OtherBCBS