Provider Demographics
NPI:1780963173
Name:BAIRD, FELICIA MARIE (SLP)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:MARIE
Last Name:BAIRD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:KLUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5156 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2663
Mailing Address - Country:US
Mailing Address - Phone:330-478-1752
Mailing Address - Fax:330-478-1763
Practice Address - Street 1:5156 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2663
Practice Address - Country:US
Practice Address - Phone:330-478-1752
Practice Address - Fax:330-478-1763
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND2012055-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3055563Medicaid
366757Medicare PIN