Provider Demographics
NPI:1528247053
Name:BAKER, SANDRA CAROLINE (CSAC)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:CAROLINE
Last Name:BAKER
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 N WEIL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3060
Mailing Address - Country:US
Mailing Address - Phone:414-962-1200
Mailing Address - Fax:414-962-2305
Practice Address - Street 1:2625 N WEIL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3060
Practice Address - Country:US
Practice Address - Phone:414-962-1200
Practice Address - Fax:414-962-2305
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12129132101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39388400Medicaid
WI12129132OtherDEPT OF REGULATION LIC