Provider Demographics
NPI:1548018450
Name:BAKER, TANESHA LYNN
Entity type:Individual
Prefix:
First Name:TANESHA
Middle Name:LYNN
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 WOODED RUN RD
Mailing Address - Street 2:
Mailing Address - City:FELICITY
Mailing Address - State:OH
Mailing Address - Zip Code:45120-9518
Mailing Address - Country:US
Mailing Address - Phone:937-515-8651
Mailing Address - Fax:
Practice Address - Street 1:555 WOODED RUN RD
Practice Address - Street 2:
Practice Address - City:FELICITY
Practice Address - State:OH
Practice Address - Zip Code:45120-9518
Practice Address - Country:US
Practice Address - Phone:937-515-8651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities