Individual
MR. JACK W BAKER III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
1730 HIDDEN HOLLOW LN NW, CEDAR RAPIDS, IA 52405-1545
(319) 393-5544
(319) 743-0014
Mailing address
1730 HIDDEN HOLLOW LN NW, CEDAR RAPIDS, IA 52405-1545
(319) 393-5544
(319) 743-0014
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
00259
IA
Other
Enumeration date
01/24/2007
Last updated
07/09/2007
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