Provider Demographics
NPI:1972596898
Name:BAILEY SPEECH AND LANGUAGE SERVICES
Entity Type:Organization
Organization Name:BAILEY SPEECH AND LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:770-995-2378
Mailing Address - Street 1:306 S. PERRY ST.
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:770-995-2378
Mailing Address - Fax:678-377-9272
Practice Address - Street 1:735 LONGLEAF BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-8443
Practice Address - Country:US
Practice Address - Phone:770-995-2378
Practice Address - Fax:678-377-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001643235Z00000X
GASLP004673235Z00000X
GASLP000631235Z00000X
GASLP005405235Z00000X
GASLP003258235Z00000X
GASLP004594235Z00000X
GASLP000710235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000666135BMedicaid
GA000584427BMedicaid
GA00902745BMedicaid
GA00970901AMedicaid
GA000584471BMedicaid
GA000831773AMedicaid
GA000587386BMedicaid