Provider Demographics
NPI:1033515317
Name:BAAB, KIRT
Entity Type:Individual
Prefix:
First Name:KIRT
Middle Name:
Last Name:BAAB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 CLUSTER DR
Mailing Address - Street 2:APT 3
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-7395
Mailing Address - Country:US
Mailing Address - Phone:231-944-0407
Mailing Address - Fax:
Practice Address - Street 1:2870 CLUSTER DR
Practice Address - Street 2:APT 3
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-7395
Practice Address - Country:US
Practice Address - Phone:231-944-0407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010899411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical