Provider Demographics
NPI:1508254053
Name:WIRZBURGER, BAILEIGH (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:BAILEIGH
Middle Name:
Last Name:WIRZBURGER
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1638
Mailing Address - Country:US
Mailing Address - Phone:508-961-9034
Mailing Address - Fax:
Practice Address - Street 1:1 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1638
Practice Address - Country:US
Practice Address - Phone:508-961-9034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9716235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist