Provider Demographics
NPI:1659056463
Name:BAILEY, EMMA KRISTINE (MS)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:KRISTINE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2616
Mailing Address - Country:US
Mailing Address - Phone:570-238-6900
Mailing Address - Fax:
Practice Address - Street 1:30 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-2061
Practice Address - Country:US
Practice Address - Phone:207-301-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST3915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist