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General NPI Number Information
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NPI Number | 1861786436
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Entity Type | Individual
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Provider Name | BRENDA LOU BAKER L.C.S.W.,L.A.D.A.C.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 4210 N FRONTAGE RD SUITE 3
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5001
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Country | US
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Telephone | 479-409-1400
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Fax | 479-301-2305
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Provider Business Mailing Address
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Address Line | 940 W BOONE ST
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-6813
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Country | US
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Telephone | 479-409-1400
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Fax | 479-301-2305
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1765-C
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License Number State | AR
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