Provider Demographics
NPI:1003001637
Name:BAILEY, CLARA MARIE
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:MARIE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 BUSINESS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7798
Mailing Address - Country:US
Mailing Address - Phone:907-622-5246
Mailing Address - Fax:907-745-5489
Practice Address - Street 1:831 S CHUGACH ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6605
Practice Address - Country:US
Practice Address - Phone:907-745-5454
Practice Address - Fax:907-746-5173
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator