Provider Demographics
NPI:1497882203
Name:BAILEY, LISA ANN (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3183 CHURCHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-4342
Mailing Address - Country:US
Mailing Address - Phone:412-668-0401
Mailing Address - Fax:
Practice Address - Street 1:135 CUMBERLAND RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5447
Practice Address - Country:US
Practice Address - Phone:412-364-1886
Practice Address - Fax:412-364-7120
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101360746Medicaid