Provider Demographics
NPI:1134791924
Name:BAILEY, LYDIA ANNE
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:ANNE
Last Name:BAILEY
Suffix:
Gender:
Credentials:
Other - Prefix:MRS
Other - First Name:LYDIA
Other - Middle Name:ANNE
Other - Last Name:CARDENAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1003 FARNHAM DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-6118
Mailing Address - Country:US
Mailing Address - Phone:435-660-0437
Mailing Address - Fax:
Practice Address - Street 1:121 W ELECTION RD STE 110
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7706
Practice Address - Country:US
Practice Address - Phone:801-525-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13412243-35011041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0Medicaid