Provider Demographics
NPI:1053474650
Name:BAILEY, WENDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 FLYNN DR
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-1508
Mailing Address - Country:US
Mailing Address - Phone:605-432-4587
Mailing Address - Fax:605-432-4580
Practice Address - Street 1:301 FLYNN DR
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1508
Practice Address - Country:US
Practice Address - Phone:605-432-4587
Practice Address - Fax:605-432-4580
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002609103TC0700X
SD569103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000961188EMedicaid
GA10032548OtherAMERIGROUP PROVIDER NUMBR
GA100651OtherCENPATICO BEHAVIORAL HLTH