Provider Demographics
NPI:1265093991
Name:BADERTSCHER, BAILEY (MA)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:BADERTSCHER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:
Other - Last Name:BYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4476 BERMUDA DUNES PL
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-5006
Mailing Address - Country:US
Mailing Address - Phone:818-808-8977
Mailing Address - Fax:
Practice Address - Street 1:4476 BERMUDA DUNES PL
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-5006
Practice Address - Country:US
Practice Address - Phone:818-808-8977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist