Provider Demographics
NPI:1104071414
Name:BAKER, JENNIFER (CAC-M)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:CAC-M
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1165 ELKVIEW DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-2055
Mailing Address - Country:US
Mailing Address - Phone:989-732-6761
Mailing Address - Fax:
Practice Address - Street 1:1165 ELKVIEW DR
Practice Address - Street 2:SUITE 3
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-2055
Practice Address - Country:US
Practice Address - Phone:989-732-6761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)