Provider Demographics
NPI:1255067971
Name:HENRY, BAYLEE BLAIN (MS SLP)
Entity type:Individual
Prefix:
First Name:BAYLEE
Middle Name:BLAIN
Last Name:HENRY
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:BAYLEE
Other - Middle Name:BLAIN
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS SLP
Mailing Address - Street 1:3215 DUTCH FOREST PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7534
Mailing Address - Country:US
Mailing Address - Phone:405-831-5464
Mailing Address - Fax:
Practice Address - Street 1:12201 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-8022
Practice Address - Country:US
Practice Address - Phone:405-752-5112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCF486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist