MEDICARE: DR. JESSICA BAKER PHD

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	103TC0700X	Clinical Psychologist	4415	NC

General Provider Information

NPI Number	:	1265772164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA BAKER PHD

Provider Business Mailing Address
First Line	:	1 BRIDGEPORT DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-8855
Country	:	US
Telephone Number	:	804-484-9935
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 MANNING DRIVE CB 7160
Second Line	:	UNIVERSITY OF NORTH CAROLINA DEPARTMENT OF PSYCHIATRY
City	:	CHAPEL HILL
State	:	NC
Zip	:	27713
Country	:	US
Telephone Number	:	919-966-1217
Fax Number	:

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

Provider Enumeration Date	:	03/01/2013
Last Update Date	:	03/01/2013

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