Provider Demographics
NPI:1760410054
Name:BAKER, JOLENE ELIZABETH (MA, ATC)
Entity Type:Individual
Prefix:MS
First Name:JOLENE
Middle Name:ELIZABETH
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 N. EMBARCADERO, #5
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219
Mailing Address - Country:US
Mailing Address - Phone:209-946-2588
Mailing Address - Fax:209-946-2190
Practice Address - Street 1:ATHLETIC DEPARTMENT
Practice Address - Street 2:3601 PACIFIC AVE.
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95211-0001
Practice Address - Country:US
Practice Address - Phone:209-946-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer