Provider Demographics
NPI:1053715383
Name:BAKER, ABIGAIL (M A)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:M A
Other - Prefix:MRS
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:NOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:738 S MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-3787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:738 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-3787
Practice Address - Country:US
Practice Address - Phone:517-263-8113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015716103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical