Healthcare Provider Details

I. General information

NPI: 1013433309
Provider Name (Legal Business Name): ABIGAIL BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4559 BENES AVE
GLEN CARBON IL
62034-1541
US

IV. Provider business mailing address

4559 BENES AVE
GLEN CARBON IL
62034-1541
US

V. Phone/Fax

Practice location:
  • Phone: 314-240-1730
  • Fax:
Mailing address:
  • Phone: 314-240-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: