Healthcare Provider Details

I. General information

NPI: 1982525911
Provider Name (Legal Business Name): LILLIAN BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 N WISNER ST
JACKSON MI
49202-3143
US

IV. Provider business mailing address

1077 N WISNER ST
JACKSON MI
49202-3143
US

V. Phone/Fax

Practice location:
  • Phone: 517-908-0639
  • Fax:
Mailing address:
  • Phone: 517-908-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7152001472APP26
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: