Provider Demographics
NPI:1457427338
Name:BAILEY SPEECH AND LANGUAGE SERVICES
Entity Type:Organization
Organization Name:BAILEY SPEECH AND LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:770-995-2378
Mailing Address - Street 1:735 LONGLEAF BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8460
Mailing Address - Country:US
Mailing Address - Phone:770-995-2378
Mailing Address - Fax:678-377-9272
Practice Address - Street 1:735 LONGLEAF BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-8460
Practice Address - Country:US
Practice Address - Phone:770-995-2378
Practice Address - Fax:678-377-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP000710235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00584471BMedicaid