Provider Demographics
NPI:1922722610
Name:BIRD, BAILI CHRISTINE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BAILI
Middle Name:CHRISTINE
Last Name:BIRD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 SADDLE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-7389
Mailing Address - Country:US
Mailing Address - Phone:325-812-5801
Mailing Address - Fax:
Practice Address - Street 1:309 W AVENUE M
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-8414
Practice Address - Country:US
Practice Address - Phone:325-657-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist