Healthcare Provider Details

I. General information

NPI: 1114846482
Provider Name (Legal Business Name): CAROLYN L BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10540 S WESTERN AVE STE 208
CHICAGO IL
60643-2529
US

IV. Provider business mailing address

10540 S WESTERN AVE STE 208
CHICAGO IL
60643-2529
US

V. Phone/Fax

Practice location:
  • Phone: 773-858-3106
  • Fax: 866-903-0238
Mailing address:
  • Phone: 773-858-3106
  • Fax: 866-903-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: