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General NPI Number Information
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NPI Number | 1033589775
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Entity Type | Organization
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Legal Business Name | LISA BAKER, PHD, LLC
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 715 HILL ST SUITE 140
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City | MADISON
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State | WI
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Zip | 53705-3542
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Country | US
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Telephone | 608-622-0376
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Fax |
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Provider Business Mailing Address
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Address Line | 715 HILL ST SUITE 140
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City | MADISON
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State | WI
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Zip | 53705-3542
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Country | US
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Telephone | 608-622-0376
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/FOUNDER
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Name | DR. LISA M BAKER
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Credential | PHD
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Telephone | 608-622-0376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 2805
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License Number State | WI
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