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General NPI Number Information
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NPI Number | 1871095950
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Entity Type | Individual
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Provider Name | JORDON LEE BAKER STNA
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Gender | Male
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 680 PARK AVE W
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City | MANSFIELD
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State | OH
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Zip | 44906-3706
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Country | US
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Telephone | 195-285-9934
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Fax | 567-560-5483
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Provider Business Mailing Address
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Address Line | 120 CARPENTER RD
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City | MANSFIELD
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State | OH
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Zip | 44903-2208
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Country | US
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Telephone | 419-543-1084
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 401880740716
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | C.2507031-TRNE
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License Number State | OH
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Taxonomy #3
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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.193137
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License Number State | OH
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