Provider Demographics
NPI:1528586534
Name:BAIRD, AMY J (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:J
Last Name:BAIRD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-3314
Mailing Address - Country:US
Mailing Address - Phone:309-444-7340
Mailing Address - Fax:
Practice Address - Street 1:5016 N UNIVERSITY ST STE 106
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4763
Practice Address - Country:US
Practice Address - Phone:309-444-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.012418OtherDEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION