Provider Demographics
NPI:1659082816
Name:BAYLOUS, AUDREY (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:
Last Name:BAYLOUS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 LINWOOD AVE SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-8499
Mailing Address - Country:US
Mailing Address - Phone:360-709-7040
Mailing Address - Fax:360-709-7042
Practice Address - Street 1:621 LINWOOD AVE SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-8499
Practice Address - Country:US
Practice Address - Phone:360-709-7040
Practice Address - Fax:360-709-7042
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP604510042355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant