Provider Demographics
NPI:1922587203
Name:BAILEY, SARA JEAN (MSW, AAC, MHP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MSW, AAC, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 UNION AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1473
Mailing Address - Country:US
Mailing Address - Phone:360-918-7860
Mailing Address - Fax:360-584-9265
Practice Address - Street 1:505 UNION AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1473
Practice Address - Country:US
Practice Address - Phone:360-918-7860
Practice Address - Fax:360-584-9265
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACG60867886OtherWASHINTON STATE DEPARTMENT OF HEALTH