Provider Demographics
NPI:1902205222
Name:CHERYL L BAIRD
Entity Type:Organization
Organization Name:CHERYL L BAIRD
Other - Org Name:FRESH START
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:630-234-3961
Mailing Address - Street 1:825 WAKEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3675
Mailing Address - Country:US
Mailing Address - Phone:630-234-3961
Mailing Address - Fax:
Practice Address - Street 1:1N121 COUNTY FARM RD
Practice Address - Street 2:SUITE 220
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2019
Practice Address - Country:US
Practice Address - Phone:630-234-3961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178-000264305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization