MEDICARE: MRS. JENNIFER JO BAKER MA-CCC/SLP-L

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	235Z00000X	Speech-Language Pathologist	22004212A	IN

General Provider Information

NPI Number	:	1598167306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER JO BAKER MA-CCC/SLP-L

Provider Business Mailing Address
First Line	:	1100 ALLISON ST
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-7874
Country	:	US
Telephone Number	:	219-743-3302
Fax Number	:	219-661-0470

Provider Business Practice Location Address
First Line	:	1100 ALLISON ST
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-7874
Country	:	US
Telephone Number	:	219-743-3302
Fax Number	:	219-661-0470

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

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	08/03/2016

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