Provider Demographics
NPI:1568009561
Name:BAIRD, JONATHON DAVID (PSYD)
Entity type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:DAVID
Last Name:BAIRD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13264 E SAGINAW WAY
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-9347
Mailing Address - Country:US
Mailing Address - Phone:559-801-8944
Mailing Address - Fax:
Practice Address - Street 1:7265 N 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2956
Practice Address - Country:US
Practice Address - Phone:559-492-1560
Practice Address - Fax:559-234-0641
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31195103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31195OtherBOARD OF PSYCHOLOGY