Provider Demographics
NPI:1396101812
Name:BAIRD, JOSEPH RYAN (BCBA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RYAN
Last Name:BAIRD
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N NILES AVE STE OP102
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1923
Mailing Address - Country:US
Mailing Address - Phone:574-393-9955
Mailing Address - Fax:574-393-9956
Practice Address - Street 1:701 N NILES AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-1923
Practice Address - Country:US
Practice Address - Phone:574-393-9955
Practice Address - Fax:574-393-9956
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-18-29317103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst