Healthcare Provider Details

I. General information

NPI: 1952091530
Provider Name (Legal Business Name): JASON BAIRD MS, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 08/13/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 CENTRE POINT CIR STE 108
NAPERVILLE IL
60563-9364
US

IV. Provider business mailing address

1760 22ND ST APT M
WHEATON IL
60189-7779
US

V. Phone/Fax

Practice location:
  • Phone: 331-207-1818
  • Fax:
Mailing address:
  • Phone: 630-346-9281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69395
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: