Healthcare Provider Details

I. General information

NPI: 1851964589
Provider Name (Legal Business Name): JILLIAN S BAITINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BIG SPRING RD
NEWVILLE PA
17241-9497
US

IV. Provider business mailing address

154 E LOUTHER ST APT D
CARLISLE PA
17013-3038
US

V. Phone/Fax

Practice location:
  • Phone: 717-776-8200
  • Fax:
Mailing address:
  • Phone: 717-941-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPSL001413
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: