MEDICARE: LAIEL INEZ BAKER-DEKREY PHD, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	MN5230	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972826501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAIEL INEZ BAKER-DEKREY PHD, LP

Provider Business Mailing Address
First Line	:	PO BOX 51
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-0051
Country	:	US
Telephone Number	:	952-443-4600
Fax Number	:	952-443-4604

Provider Business Practice Location Address
First Line	:	1772 STIEGER LAKE LN STE 220
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-7723
Country	:	US
Telephone Number	:	952-443-4600
Fax Number	:	952-443-4604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2010
Last Update Date	:	04/08/2019

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