Individual
MISS MAKENZIE BAKER X
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
407 N BASIN RD, FAIRFIELD, IL 62837-9639
(618) 842-2125
(618) 842-4154
Mailing address
504 MICAH DR, DRAWER M, OLNEY, IL 62450-4720
(618) 395-4306
(618) 395-4507
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
09/24/2015
Last updated
09/24/2015
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