Individual
MAKAYLA BAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 STILL WATER DR, O FALLON, IL 62269-3482
(618) 593-4688
Mailing address
1001 STILL WATER DR, O FALLON, IL 62269-3482
(618) 593-4688
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
B260-5559-8818
IL
Other
Enumeration date
06/19/2019
Last updated
06/19/2019
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