Basic Information
| Provider Information | |||||||||
| NPI: | 1619235926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | DAWN | ||||||||
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| Credential: | PLMHP, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10748 VIRGINIA PLZ | ||||||||
| Address2: | STE 107 | ||||||||
| City: | LAVISTA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029334411 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1941 S 42ND ST | ||||||||
| Address2: | STE 514 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681052939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026148444 | ||||||||
| FaxNumber: | 4026148443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2012 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | N | Other Service Providers | Community Health Worker | 101YM0800X | NE | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.