Healthcare Provider Details

I. General information

NPI: 1760434401
Provider Name (Legal Business Name): CLAUDETTE T BAKER L.AC. /HERBS(NCCAOM)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 GLENVIEW RD
GLENVIEW IL
60025
US

IV. Provider business mailing address

1757 GLENVIEW RD
GLENVIEW IL
60025
US

V. Phone/Fax

Practice location:
  • Phone: 847-998-8860
  • Fax: 847-998-8863
Mailing address:
  • Phone: 847-998-8860
  • Fax: 847-998-8863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198000059
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: