Provider Demographics
NPI:1811747298
Name:JESSICA N BAKER PLLC
Entity type:Organization
Organization Name:JESSICA N BAKER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WAJAHATUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-600-5061
Mailing Address - Street 1:2 S ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-2126
Mailing Address - Country:US
Mailing Address - Phone:312-600-5061
Mailing Address - Fax:
Practice Address - Street 1:2 S ADDISON ST
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-2126
Practice Address - Country:US
Practice Address - Phone:312-600-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health