Provider Demographics
NPI:1043514284
Name:BAILEY, TANYA (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:WELSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:349 HAMLINE AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2407
Mailing Address - Country:US
Mailing Address - Phone:651-307-0981
Mailing Address - Fax:
Practice Address - Street 1:349 HAMLINE AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2407
Practice Address - Country:US
Practice Address - Phone:651-307-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN137171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical