MEDICARE: JORDAN NICHOLE BAKER

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1770447203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN NICHOLE BAKER

Provider Business Mailing Address
First Line	:	2614 CHARLESTOWN ROAD
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150
Country	:	US
Telephone Number	:	812-250-2232
Fax Number	:

Provider Business Practice Location Address
First Line	:	2614 CHARLESTOWN ROAD
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150
Country	:	US
Telephone Number	:	812-250-2232
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ JORDAN NICHOLE BAKER ” Practice Location

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