Provider Demographics
NPI:1497577209
Name:STAAB, BAILIE JADE (PLADC)
Entity type:Individual
Prefix:
First Name:BAILIE
Middle Name:JADE
Last Name:STAAB
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HEATHER RD
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-1741
Mailing Address - Country:US
Mailing Address - Phone:308-641-3646
Mailing Address - Fax:
Practice Address - Street 1:17 HEATHER RD
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-1741
Practice Address - Country:US
Practice Address - Phone:308-641-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)