Provider Demographics
NPI:1770758328
Name:BAKER, JENNIFER W
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:WHALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 JOHN MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25755-0001
Mailing Address - Country:US
Mailing Address - Phone:304-696-3641
Mailing Address - Fax:304-696-2986
Practice Address - Street 1:1 JOHN MARSHALL DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-0001
Practice Address - Country:US
Practice Address - Phone:304-696-3641
Practice Address - Fax:304-696-2986
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-8987235Z00000X
WVSLP-1204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0094740Medicaid
WV3810016635Medicaid
WVBA4315421Medicare PIN