Provider Demographics
NPI:1093187387
Name:BAIL, AMELIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMELIE
Middle Name:
Last Name:BAIL
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 1:1627 CARRIAGE HOUSE TER
Mailing Address - Street 2:APT I
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2289
Mailing Address - Country:US
Mailing Address - Phone:978-235-3864
Mailing Address - Fax:
Practice Address - Street 1:1627 CARRIAGE HOUSE TER
Practice Address - Street 2:APT I
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2289
Practice Address - Country:US
Practice Address - Phone:978-235-3864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist