Provider Demographics
NPI:1891223996
Name:BAIRD, JENNIFER (LMT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:BAIRD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E 1ST AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2653
Mailing Address - Country:US
Mailing Address - Phone:801-674-8434
Mailing Address - Fax:
Practice Address - Street 1:320 E 1ST AVE APT 4
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2653
Practice Address - Country:US
Practice Address - Phone:801-674-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8430080-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty