Healthcare Provider Details

I. General information

NPI: 1114717931
Provider Name (Legal Business Name): TIM BAYNES, LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13554 S KALAMAZOO CT
PLAINFIELD IL
60544-7048
US

IV. Provider business mailing address

13554 S KALAMAZOO CT
PLAINFIELD IL
60544-7048
US

V. Phone/Fax

Practice location:
  • Phone: 847-828-1678
  • Fax:
Mailing address:
  • Phone: 847-828-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. TIMOTHY M BAYNES JR.
Title or Position: PRESIDENT
Credential: LCSW
Phone: 847-828-1678