Provider Demographics
NPI:1316102510
Name:BAIRD, JILL C (PHD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:C
Last Name:BAIRD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24300 CHAGRIN BLVD STE 309
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5629
Mailing Address - Country:US
Mailing Address - Phone:216-223-7169
Mailing Address - Fax:216-230-6099
Practice Address - Street 1:24300 CHAGRIN BLVD
Practice Address - Street 2:STE 309
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5629
Practice Address - Country:US
Practice Address - Phone:216-223-7169
Practice Address - Fax:216-230-6099
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017729103TC0700X
PAPS018167103TC0700X
OHP08020103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical