Provider Demographics
NPI:1396862579
Name:BAIRD, MICHAEL J (MS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BAIRD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1645
Mailing Address - Country:US
Mailing Address - Phone:319-754-4242
Mailing Address - Fax:319-754-4079
Practice Address - Street 1:1201 W AGENCY RD
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1645
Practice Address - Country:US
Practice Address - Phone:319-754-4242
Practice Address - Fax:319-754-4079
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00482103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA107314000OtherIOWA PLAN