Provider Demographics
NPI:1255049722
Name:HERRALD, BAILEY MAE
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:MAE
Last Name:HERRALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-8436
Mailing Address - Country:US
Mailing Address - Phone:563-543-7859
Mailing Address - Fax:
Practice Address - Street 1:2410 MARTIN DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-8436
Practice Address - Country:US
Practice Address - Phone:563-543-7859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty