Provider Demographics
NPI:1255025466
Name:EDWARDS, BAYLEY MARIE
Entity type:Individual
Prefix:
First Name:BAYLEY
Middle Name:MARIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BAYLEY
Other - Middle Name:
Other - Last Name:NEECE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62474-1015
Mailing Address - Country:US
Mailing Address - Phone:217-690-3096
Mailing Address - Fax:
Practice Address - Street 1:815 W VINE ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IL
Practice Address - Zip Code:62474-1015
Practice Address - Country:US
Practice Address - Phone:217-690-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46004265A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist