Provider Demographics
NPI:1487868436
Name:BAKER, JASON JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JOHN
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E BETHANY HOME RD
Mailing Address - Street 2:SUITE A-125
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1263
Mailing Address - Country:US
Mailing Address - Phone:602-230-8324
Mailing Address - Fax:602-274-7402
Practice Address - Street 1:301 E BETHANY HOME RD
Practice Address - Street 2:SUITE A-125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1263
Practice Address - Country:US
Practice Address - Phone:602-230-8324
Practice Address - Fax:602-274-7402
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3711103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist