Provider Demographics
NPI:1598167306
Name:BAKER, JENNIFER JO (MA-CCC/SLP-L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JO
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA-CCC/SLP-L
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:JO
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA-CCC/SLP-L
Mailing Address - Street 1:1100 ALLISON ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7874
Mailing Address - Country:US
Mailing Address - Phone:219-743-3302
Mailing Address - Fax:219-661-0470
Practice Address - Street 1:1100 ALLISON ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7874
Practice Address - Country:US
Practice Address - Phone:219-743-3302
Practice Address - Fax:219-661-0470
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004212A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist