Provider Demographics
NPI:1356523427
Name:BAKER-ROSEBORO, KENDRA D (LCPC)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:D
Last Name:BAKER-ROSEBORO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MISS
Other - First Name:KENDRA
Other - Middle Name:DARREKA
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11553 S LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4827
Mailing Address - Country:US
Mailing Address - Phone:773-233-6393
Mailing Address - Fax:
Practice Address - Street 1:11553 S LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4827
Practice Address - Country:US
Practice Address - Phone:773-233-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor