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Organization
CARLY BAKER
Active
Organization
CARLY BAKER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLY JEAN BAKER (LPN)
(608) 792-2646
Entity
Organization
Contact information
Practice address
146 E TILSON ST., WEST SALEM, WI 54669-1213
(608) 792-2646
Mailing address
146 TILSON ST E, WEST SALEM, WI 54669-1213
(608) 792-2646
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
302971-031
WI
Other
Enumeration date
09/01/2010
Last updated
09/01/2010
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