Provider Demographics
NPI:1679124119
Name:WORSTELL, BAILEY DANIELLE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:DANIELLE
Last Name:WORSTELL
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28260 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:MALTA BEND
Mailing Address - State:MO
Mailing Address - Zip Code:65339-1412
Mailing Address - Country:US
Mailing Address - Phone:316-617-8014
Mailing Address - Fax:
Practice Address - Street 1:467 S ELLSWORTH AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-1916
Practice Address - Country:US
Practice Address - Phone:660-886-3993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019034861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist