MEDICARE: MRS. KENDRA D. BAKER-ROSEBORO L.C.P.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		IL

General Provider Information

NPI Number	:	1356523427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENDRA D. BAKER-ROSEBORO L.C.P.C

Provider Business Mailing Address
First Line	:	11553 S LONGWOOD DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4827
Country	:	US
Telephone Number	:	773-233-6393
Fax Number	:

Provider Business Practice Location Address
First Line	:	11553 S LONGWOOD DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4827
Country	:	US
Telephone Number	:	773-233-6393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2007
Last Update Date	:	01/04/2008

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