Provider Demographics
NPI:1760637326
Name:BAKER, JESSICA (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 F ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6325
Mailing Address - Country:US
Mailing Address - Phone:707-822-4300
Mailing Address - Fax:707-822-4330
Practice Address - Street 1:607 F ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6325
Practice Address - Country:US
Practice Address - Phone:707-822-4300
Practice Address - Fax:707-822-4330
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12703171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist