=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881728921
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER RAE BAKER MA, MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5300 CLAUS RD STE 18
-----------------------------------------------------
City | RIVERBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95367-1667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-204-3086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5300 CLAUS RD STE 18
-----------------------------------------------------
City | RIVERBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95367-1667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 38734
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------