Healthcare Provider Details

I. General information

NPI: 1366196701
Provider Name (Legal Business Name): DAN BAIRD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N GRANT ST
SALT LAKE CITY UT
84116-2725
US

IV. Provider business mailing address

440 S 500 E
SALT LAKE CITY UT
84102-2705
US

V. Phone/Fax

Practice location:
  • Phone: 385-500-4259
  • Fax:
Mailing address:
  • Phone: 385-256-6087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5498907-6006
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5498907-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: