Provider Information for 1104046721
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DOROTHY CHAFFEE BAKER LCSW
Sex: Female
NPI: 1104046721
Last Updated: 2022-01-28
Certification Date: 2022-01-28
Certification Date: 2022-01-28
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1104046721 | ||||||||||||
| Enumeration Date | 2007-04-26 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1300 E BRADFORD PKWY SPRINGFIELD, MO 65804-4264 United States Phone: 417-761-5000 | Fax:417-761-5011 | ||||||||||||
| Primary Practice Address | 1300 E BRADFORD PKWY SPRINGFIELD, MO 65804-4264 United States Phone: 417-761-5000 | Fax:417-761-5011 | ||||||||||||
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