Individual
KELLY MARIE BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
121 S MADISON, PITTSFIELD, IL 62363
(217) 285-4436
(217) 285-2804
Mailing address
1301 N 2353RD LN, MENDON, IL 62351
(217) 440-6200
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/12/2007
Last updated
07/08/2007
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