MEDICARE: MS. JACQUELINE BAKER MH21380

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	101YM0800X	Mental Health Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1326415662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE BAKER MH21380

Provider Business Mailing Address
First Line	:	1453 WINNEBAGO AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-1156
Country	:	US
Telephone Number	:	754-264-5084
Fax Number	:

Provider Business Practice Location Address
First Line	:	580 ELLIS RD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-3582
Country	:	US
Telephone Number	:	904-423-0017
Fax Number	:

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

Provider Enumeration Date	:	08/21/2015
Last Update Date	:	06/05/2026

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