Provider Demographics
NPI:1023545191
Name:MCKEON, BAILEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:MCKEON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 RESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:PA
Mailing Address - Zip Code:19560-9216
Mailing Address - Country:US
Mailing Address - Phone:610-301-9637
Mailing Address - Fax:
Practice Address - Street 1:1925 W TURNER ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5513
Practice Address - Country:US
Practice Address - Phone:610-794-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist