Provider Demographics
NPI:1205936036
Name:BAILEY, BEVERLY LYNN (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:LYNN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 ROBINSON WALK APT A
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-5892
Mailing Address - Country:US
Mailing Address - Phone:423-202-8528
Mailing Address - Fax:
Practice Address - Street 1:100 NETHERLAND LN
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7245
Practice Address - Country:US
Practice Address - Phone:423-245-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist