Provider Demographics
NPI:1316430002
Name:BAECKER, PAUL RAYMOND (MA, NCC, LPCC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:RAYMOND
Last Name:BAECKER
Suffix:
Gender:M
Credentials:MA, NCC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CATO AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55808-1150
Mailing Address - Country:US
Mailing Address - Phone:715-495-5600
Mailing Address - Fax:218-260-2611
Practice Address - Street 1:324 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1701
Practice Address - Country:US
Practice Address - Phone:218-606-1797
Practice Address - Fax:218-260-2611
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6948-125101YP2500X
MNCC02111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional