Healthcare Provider Details

I. General information

NPI: 1578018529
Provider Name (Legal Business Name): COLLEEN W BAIRD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 N PORT WASHINGTON RD STE 200
GLENDALE WI
53217-4927
US

IV. Provider business mailing address

5450 N LYDELL AVE
WHITEFISH BAY WI
53217-5005
US

V. Phone/Fax

Practice location:
  • Phone: 262-789-1191
  • Fax:
Mailing address:
  • Phone: 608-692-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5998
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: