Provider Demographics
NPI:1558915058
Name:BAILEY, KATHERINE SUZANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUZANNE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6299 HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:GOODMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39079-9584
Mailing Address - Country:US
Mailing Address - Phone:601-573-1641
Mailing Address - Fax:
Practice Address - Street 1:6299 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:GOODMAN
Practice Address - State:MS
Practice Address - Zip Code:39079-9584
Practice Address - Country:US
Practice Address - Phone:601-573-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS127910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist