Provider Demographics
NPI:1710539952
Name:PERUSKI, BAILEY LYNN
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:LYNN
Last Name:PERUSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8413 SOUTH UBLY ROAD
Mailing Address - Street 2:
Mailing Address - City:UBLY
Mailing Address - State:MI
Mailing Address - Zip Code:48475
Mailing Address - Country:US
Mailing Address - Phone:989-553-3888
Mailing Address - Fax:
Practice Address - Street 1:8413 SOUTH UBLY ROAD
Practice Address - Street 2:
Practice Address - City:UBLY
Practice Address - State:MI
Practice Address - Zip Code:48475
Practice Address - Country:US
Practice Address - Phone:989-553-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI6851114276104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician