Healthcare Provider Details

I. General information

NPI: 1508215286
Provider Name (Legal Business Name): KAREN BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 FOXFIELD RD STE 202
ST CHARLES IL
60174-1402
US

IV. Provider business mailing address

2075 FOXFIELD RD STE 202
ST CHARLES IL
60174-1402
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-3535
  • Fax: 630-377-6703
Mailing address:
  • Phone: 630-377-3535
  • Fax: 630-377-6703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.009301
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: