Provider Demographics
NPI:1891016879
Name:BAILEY, LAUREN BUCHANAN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BUCHANAN
Last Name:BAILEY
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 1:148 GRAY STATION RD
Mailing Address - Street 2:#104
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4840
Mailing Address - Country:US
Mailing Address - Phone:865-851-4717
Mailing Address - Fax:
Practice Address - Street 1:2005 VENTURE PARK
Practice Address - Street 2:SUITE 17
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-1098
Practice Address - Country:US
Practice Address - Phone:423-207-1260
Practice Address - Fax:423-373-1246
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist