MEDICARE: JESSICA HAAKER

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	101YM0800X	Mental Health Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1861238172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HAAKER

Provider Business Mailing Address
First Line	:	600 WAYNE AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-1199
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4950 NORTHCUTT PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-3840
Country	:	US
Telephone Number	:	937-496-2000
Fax Number	:

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

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	12/22/2025

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Directions to “ JESSICA HAAKER ” Practice Location

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