Provider Demographics
NPI:1114637279
Name:BAKER, JEFFREY D (CDCA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
Last Name:BAKER
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 SHERMAN CHURCH AVE SW LOT 2609
Mailing Address - Street 2:
Mailing Address - City:EAST SPARTA
Mailing Address - State:OH
Mailing Address - Zip Code:44626-9462
Mailing Address - Country:US
Mailing Address - Phone:330-327-7494
Mailing Address - Fax:
Practice Address - Street 1:721 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-6829
Practice Address - Country:US
Practice Address - Phone:855-712-9962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.175216101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)