Provider Demographics
NPI:1871095950
Name:BAKER, JORDON LEE (STNA)
Entity type:Individual
Prefix:
First Name:JORDON
Middle Name:LEE
Last Name:BAKER
Suffix:
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2208
Mailing Address - Country:US
Mailing Address - Phone:419-543-1084
Mailing Address - Fax:
Practice Address - Street 1:680 PARK AVE W
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3706
Practice Address - Country:US
Practice Address - Phone:195-285-9934
Practice Address - Fax:567-560-5483
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401880740716374U00000X
OHCDCA.193137101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No374U00000XNursing Service Related ProvidersHome Health Aide