MEDICARE: DANA LYNN BAKER LCPC

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	101YP2500X	Professional Counselor	178.012562	IL
2	101YP2500X	Professional Counselor	180.012875	IL

General Provider Information

NPI Number	:	1508300740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA LYNN BAKER LCPC

Provider Business Mailing Address
First Line	:	2501 SOUTHWOOD DR
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61821-5720
Country	:	US
Telephone Number	:	847-915-8654
Fax Number	:	217-398-9077

Provider Business Practice Location Address
First Line	:	3015 VILLAGE OFFICE PL # B
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-7674
Country	:	US
Telephone Number	:	217-239-6085
Fax Number	:	217-356-7964

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

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	09/24/2021

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Directions to “ DANA LYNN BAKER LCPC” Practice Location

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