MEDICARE: SHANNON R BAKER

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	101YP2500X	Professional Counselor	C.2406362	OH

General Provider Information

NPI Number	:	1881407898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON R BAKER

Provider Business Mailing Address
First Line	:	5900 N MAIN ST STE 3
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-3106
Country	:	US
Telephone Number	:	937-277-9371
Fax Number	:	937-277-7734

Provider Business Practice Location Address
First Line	:	5900 N MAIN ST STE 3
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-3106
Country	:	US
Telephone Number	:	937-277-9371
Fax Number	:	937-277-7734

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

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	01/31/2025

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Directions to “ SHANNON R BAKER ” Practice Location

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