Provider Demographics
NPI:1518731850
Name:BAILEY, ALESHA RAE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALESHA
Middle Name:RAE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22011 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562-6842
Mailing Address - Country:US
Mailing Address - Phone:601-678-9001
Mailing Address - Fax:
Practice Address - Street 1:4214 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5975
Practice Address - Country:US
Practice Address - Phone:228-218-3362
Practice Address - Fax:228-366-9062
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS5035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist