Provider Demographics
NPI:1861543894
Name:SLIGO-BAKER, STEPHANIE (MSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SLIGO-BAKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 SHINGLE CREEK PKWY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430
Mailing Address - Country:US
Mailing Address - Phone:763-560-4860
Mailing Address - Fax:763-503-1430
Practice Address - Street 1:2105 WEST 143RD STREET #B
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-8000
Practice Address - Country:US
Practice Address - Phone:952-303-6832
Practice Address - Fax:952-303-3434
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16535101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor