Provider Demographics
NPI:1902107618
Name:BAIRD, ROURK N (APC)
Entity Type:Individual
Prefix:MR
First Name:ROURK
Middle Name:N
Last Name:BAIRD
Suffix:
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7923 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-7768
Mailing Address - Country:US
Mailing Address - Phone:801-699-3309
Mailing Address - Fax:
Practice Address - Street 1:7923 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-7768
Practice Address - Country:US
Practice Address - Phone:801-699-3309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6746508-6009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional