Provider Demographics
NPI:1508129248
Name:BAIRD, JOANN MEDWID (MFT)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:MEDWID
Last Name:BAIRD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W PLUMB LN
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3766
Mailing Address - Country:US
Mailing Address - Phone:925-699-4765
Mailing Address - Fax:775-376-1966
Practice Address - Street 1:421 W PLUMB LN
Practice Address - Street 2:SUITE A-1
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3766
Practice Address - Country:US
Practice Address - Phone:925-699-4765
Practice Address - Fax:775-376-1966
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NV01295106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101YM0800XMedicaid