Individual
MCLAIN BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHP
Contact information
Practice address
1016 S MADISON ST, DU QUOIN, IL 62832-2442
(618) 542-4357
(618) 542-3442
Mailing address
1016 S MADISON ST, DU QUOIN, IL 62832-2442
(618) 542-4357
(618) 542-3442
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BB26055800903
DRIVERS LICENSE
IL
Enumeration date
05/02/2022
Last updated
05/02/2022
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