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General NPI Number Information
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NPI Number | 1114637279
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Entity Type | Individual
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Provider Name | JEFFREY D. BAKER CDCA
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Gender | Male
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 721 LINCOLN WAY E
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City | MASSILLON
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State | OH
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Zip | 44646-6829
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Country | US
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Telephone | 855-712-9962
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Fax |
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Provider Business Mailing Address
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Address Line | 7373 SHERMAN CHURCH AVE SW LOT 2609
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City | EAST SPARTA
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State | OH
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Zip | 44626-9462
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Country | US
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Telephone | 330-327-7494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.175216
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License Number State | OH
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