Provider Demographics
NPI:1124592142
Name:BAYLIS, ANNA LOUISE (LICSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LOUISE
Last Name:BAYLIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:LOUISE
Other - Last Name:BAYLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-1045
Mailing Address - Country:US
Mailing Address - Phone:907-224-5257
Mailing Address - Fax:907-224-7081
Practice Address - Street 1:302 RAILWAY AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664-0999
Practice Address - Country:US
Practice Address - Phone:907-224-5257
Practice Address - Fax:907-224-7081
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3843C1041C0700X, 1041C0700X
AK1584131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical