Provider Demographics
NPI:1326518267
Name:BAKER, JENNIFER SUE
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUE
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35369 TINGLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLARDS
Mailing Address - State:MD
Mailing Address - Zip Code:21874-1323
Mailing Address - Country:US
Mailing Address - Phone:443-735-6837
Mailing Address - Fax:
Practice Address - Street 1:515 COULBOURNE LN
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863-4014
Practice Address - Country:US
Practice Address - Phone:410-632-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist