Provider Demographics
NPI:1750488516
Name:BAYRD, MARY J (MA ED SPEC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:J
Last Name:BAYRD
Suffix:
Gender:F
Credentials:MA ED SPEC
Other - Prefix:
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Mailing Address - Street 1:6542 REGENCY LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7847
Mailing Address - Country:US
Mailing Address - Phone:952-903-9203
Mailing Address - Fax:952-903-9257
Practice Address - Street 1:6542 REGENCY LN
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7847
Practice Address - Country:US
Practice Address - Phone:952-903-9203
Practice Address - Fax:952-903-9257
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP 1463103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent