Healthcare Provider Details

I. General information

NPI: 1376636209
Provider Name (Legal Business Name): DOROTHY B. BAKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOROTHY B. WARE OR BAJGERT

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 MC CLELLAND BLVD
JOPLIN MO
64804-1632
US

IV. Provider business mailing address

PO BOX 2526
JOPLIN MO
64803-2526
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-7580
  • Fax: 417-347-7582
Mailing address:
  • Phone: 417-347-7600
  • Fax: 417-347-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002150
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: