Healthcare Provider Details

I. General information

NPI: 1235253501
Provider Name (Legal Business Name): JEFFERY L BAKER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 TOLBERT RD
HAMILTON OH
45011
US

IV. Provider business mailing address

1900 TOLBERT RD
HAMILTON OH
45011-9642
US

V. Phone/Fax

Practice location:
  • Phone: 513-726-5551
  • Fax: 513-726-5551
Mailing address:
  • Phone: 513-478-4917
  • Fax: 513-452-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6450
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number923219
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: