Healthcare Provider Details

I. General information

NPI: 1396101812
Provider Name (Legal Business Name): JOSEPH RYAN BAIRD BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 LINCOLN WAY E
SOUTH BEND IN
46601-3250
US

IV. Provider business mailing address

750 LINCOLN WAY E
SOUTH BEND IN
46601-3250
US

V. Phone/Fax

Practice location:
  • Phone: 574-786-0088
  • Fax: 574-366-0080
Mailing address:
  • Phone: 574-786-0088
  • Fax: 574-366-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-29317
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: