MEDICARE: DR. JENNIFER L. BAKER PSYD

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	2004024716	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487673182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER L. BAKER PSYD

Provider Business Mailing Address
First Line	:	3594 W GREENWOOD ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5538
Country	:	US
Telephone Number	:	417-425-6091
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 E WALNUT ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65806-2303
Country	:	US
Telephone Number	:	417-425-6091
Fax Number	:

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	10/05/2024

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