Provider Demographics
NPI:1003051335
Name:BAILEY, ELIZABETH GUILLORY (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:GUILLORY
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12264 QUEENSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-6750
Mailing Address - Country:US
Mailing Address - Phone:337-412-1344
Mailing Address - Fax:
Practice Address - Street 1:12264 QUEENSBURY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-6750
Practice Address - Country:US
Practice Address - Phone:337-412-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2024-03-21
Deactivation Date:2020-05-26
Deactivation Code:
Reactivation Date:2024-03-21
Provider Licenses
StateLicense IDTaxonomies
LA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist