Provider Demographics
NPI:1073888681
Name:BAILLY, NANCY LEIGH (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LEIGH
Last Name:BAILLY
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 1:350 W DEANS MILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST COXSACKIE
Mailing Address - State:NY
Mailing Address - Zip Code:12192-2506
Mailing Address - Country:US
Mailing Address - Phone:518-929-2894
Mailing Address - Fax:
Practice Address - Street 1:73 ROUTE 11A
Practice Address - Street 2:
Practice Address - City:CRARYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12521-5510
Practice Address - Country:US
Practice Address - Phone:518-325-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist