Healthcare Provider Details

I. General information

NPI: 1871095950
Provider Name (Legal Business Name): JORDON LEE BAKER STNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 PARK AVE W
MANSFIELD OH
44906-3706
US

IV. Provider business mailing address

120 CARPENTER RD
MANSFIELD OH
44903-2208
US

V. Phone/Fax

Practice location:
  • Phone: 195-285-9934
  • Fax: 567-560-5483
Mailing address:
  • Phone: 419-543-1084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number401880740716
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberC.2507031-TRNE
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.193137
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: