Provider Demographics
NPI:1124537691
Name:DRAKE, BAILEY J (LISW)
Entity Type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:J
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 COTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1012
Mailing Address - Country:US
Mailing Address - Phone:641-782-8457
Mailing Address - Fax:
Practice Address - Street 1:600 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:IA
Practice Address - Zip Code:50851-1327
Practice Address - Country:US
Practice Address - Phone:641-344-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086075104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1124537691Medicaid