Provider Demographics
NPI:1821232307
Name:BAILEY, MELANIE L (MED)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 CRICKHOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-2710
Mailing Address - Country:US
Mailing Address - Phone:804-399-3642
Mailing Address - Fax:
Practice Address - Street 1:4101 NINE MILE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-4956
Practice Address - Country:US
Practice Address - Phone:804-222-1694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist