Jaquelin Baker

Key facts

NPI

1609650233

Entity type

Individual (NPI type 1)

Primary specialty

Behavior Technician 106S00000X

License

RBT-23-285565

Practice address

14155 92 Hwy
Platte City, MO 64079-8907

Phone

(816) 831-1770

Fax

(800) 687-5070

NPI assigned

Aug 23, 2023

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Autism Support Now, LLC Behavior Analyst · Independence, MO · NPI 1033636956
  NPD

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 23, 2023.

{
    "created_epoch": "1692748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1609650233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4721 S CLIFF AVE STE 103",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640556969",
            "telephone_number": "816-608-1956",
            "fax_number": "800-687-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14155 92 HWY",
            "city": "PLATTE CITY",
            "state": "MO",
            "postal_code": "640798907",
            "telephone_number": "816-831-1770",
            "fax_number": "800-687-5070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "JAQUELIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-23",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": "RBT-23-285565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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