Provider Demographics
NPI:1497483275
Name:HENDERLONG, BAILEY (AUD)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:HENDERLONG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 CENTERVILLE BUSINESS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2690
Mailing Address - Country:US
Mailing Address - Phone:937-435-7476
Mailing Address - Fax:
Practice Address - Street 1:6601 CENTERVILLE BUSINESS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2690
Practice Address - Country:US
Practice Address - Phone:937-435-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist