MEDICARE: MS. JENNIFER ANNETTE BAKER M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1023132586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ANNETTE BAKER M.A.

Provider Business Mailing Address
First Line	:	138 TALL TIMBERS LN
Second Line	:
City	:	MONTICELLO
State	:	KY
Zip	:	42633-3248
Country	:	US
Telephone Number	:	606-219-3155
Fax Number	:	606-348-7241

Provider Business Practice Location Address
First Line	:	138 TALL TIMBERS LN
Second Line	:
City	:	MONTICELLO
State	:	KY
Zip	:	42633-3248
Country	:	US
Telephone Number	:	606-219-3155
Fax Number	:	606-348-7241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	06/06/2016

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