Provider Demographics
NPI:1144344128
Name:BAIRD, REBECCA ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANNE
Last Name:BAIRD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANNE
Other - Last Name:DULL-BAIRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:917 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1617
Mailing Address - Country:US
Mailing Address - Phone:248-547-2594
Mailing Address - Fax:
Practice Address - Street 1:1 FORD PL
Practice Address - Street 2:1-E
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3450
Practice Address - Country:US
Practice Address - Phone:313-876-2526
Practice Address - Fax:313-876-7649
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005026103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist