MEDICARE: JACQUELINE M BAQUET

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1831766799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE M BAQUET

Provider Business Mailing Address
First Line	:	200 W COMMERCE ST APT 353
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-1396
Country	:	US
Telephone Number	:	214-399-7121
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 FOREST LN STE A204
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2583
Country	:	US
Telephone Number	:	972-566-4119
Fax Number	:

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

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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Directions to “ JACQUELINE M BAQUET ” Practice Location

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