Provider Demographics
NPI:1801560115
Name:BAASKE, JENNIFER ELLEN (DPT, RTY-200)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELLEN
Last Name:BAASKE
Suffix:
Gender:F
Credentials:DPT, RTY-200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1914
Mailing Address - Fax:630-928-5014
Practice Address - Street 1:1801 W MAUMEE ST STE 125
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1397
Practice Address - Country:US
Practice Address - Phone:517-264-6141
Practice Address - Fax:517-263-5786
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2023-08-08
Deactivation Date:2022-08-31
Deactivation Code:
Reactivation Date:2023-08-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist