Provider Demographics
NPI:1245913664
Name:BAKER, DEVON AUSTIN
Entity type:Individual
Prefix:MR
First Name:DEVON
Middle Name:AUSTIN
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 1:3085 22ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-3544
Mailing Address - Country:US
Mailing Address - Phone:304-972-1953
Mailing Address - Fax:
Practice Address - Street 1:1500 COLONIAL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1025
Practice Address - Country:US
Practice Address - Phone:786-523-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician