Provider Demographics
NPI:1346583804
Name:BAKEMAN, JO ANNE (RN, CASAC)
Entity type:Individual
Prefix:MS
First Name:JO ANNE
Middle Name:
Last Name:BAKEMAN
Suffix:
Gender:F
Credentials:RN, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E PATRICIA LN
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3218
Mailing Address - Country:US
Mailing Address - Phone:315-458-2538
Mailing Address - Fax:315-458-2538
Practice Address - Street 1:163 S 1ST ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1721
Practice Address - Country:US
Practice Address - Phone:315-427-3899
Practice Address - Fax:315-458-2538
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4364101YA0400X
NY252125-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse