Provider Demographics
NPI:1922581362
Name:BAKER, JARED KEITH
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:KEITH
Last Name:BAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6573 SWEET CLOVER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-9123
Mailing Address - Country:US
Mailing Address - Phone:517-877-0436
Mailing Address - Fax:
Practice Address - Street 1:45 E BACON ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1637
Practice Address - Country:US
Practice Address - Phone:517-224-2062
Practice Address - Fax:517-224-2062
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X, 103TP2701X
MI6301013237103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy