Healthcare Provider Details

I. General information

NPI: 1033836168
Provider Name (Legal Business Name): ROBERT BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBBIE BAKER

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 8TH ST S STE B
VIRGINIA MN
55792-3236
US

IV. Provider business mailing address

PO BOX 236
COTTON MN
55724-0236
US

V. Phone/Fax

Practice location:
  • Phone: 218-748-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33855
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: