Provider Demographics
NPI:1376796292
Name:BAILEY, CAROLYN ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ANN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S BLOOMINGDALE RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2952
Mailing Address - Country:US
Mailing Address - Phone:630-306-6800
Mailing Address - Fax:630-893-7481
Practice Address - Street 1:125 S BLOOMINGDALE RD
Practice Address - Street 2:SUITE 12
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2952
Practice Address - Country:US
Practice Address - Phone:630-306-6800
Practice Address - Fax:630-893-7481
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006012103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist