Provider Demographics
NPI:1720787559
Name:BAKER, HEATHER C
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:C
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 1:7673 E BETHEL LN
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:IL
Mailing Address - Zip Code:62419-2212
Mailing Address - Country:US
Mailing Address - Phone:618-863-1143
Mailing Address - Fax:
Practice Address - Street 1:7673 E BETHEL LN
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:IL
Practice Address - Zip Code:62419-2212
Practice Address - Country:US
Practice Address - Phone:618-863-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator