Provider Demographics
NPI:1457010217
Name:MASSEY, BAILEY (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:
Other - Last Name:DUEMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:2661 CASTLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-8908
Mailing Address - Country:US
Mailing Address - Phone:818-314-4273
Mailing Address - Fax:
Practice Address - Street 1:2661 CASTLE CREST DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-8908
Practice Address - Country:US
Practice Address - Phone:818-314-4273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19379235Z00000X
CO0004529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist