MEDICARE: JULIE A BAXTER CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCAPRE.196024	OH

General Provider Information

NPI Number	:	1053031591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE A BAXTER CDCA

Provider Business Mailing Address
First Line	:	2600 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1395
Country	:	US
Telephone Number	:	513-751-7747
Fax Number	:	513-751-0180

Provider Business Practice Location Address
First Line	:	4966 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3905
Country	:	US
Telephone Number	:	513-751-7747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	06/08/2026

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