Doctor Name: | MS. JENNIFER BAKER |
NPI Number: | 1104071414 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CAC-M |
License Number: | |
Business Practice Address: | 1165 Elkview Dr Suite 3 Gaylord, MI - 497352055 |
Business Phone Number: | 9897326761 |
Business Fax Number: | |
Mailing Address: | 1165 Elkview Dr, Suite 3 GAYLORD |
State: | MI |
Postal Code: | 497352055 |
Phone Number: | 9897326761 |
Fax Number: | |
NPI Enumeration Date: | 12/01/2008 |
NPI Last Update Date: | 12/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |