Provider Demographics
NPI:1700260155
Name:MODERSON, BAILEY G (AUD)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:G
Last Name:MODERSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:G
Other - Last Name:BASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 19087
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66285-9087
Mailing Address - Country:US
Mailing Address - Phone:913-262-5855
Mailing Address - Fax:913-262-5869
Practice Address - Street 1:1001 6TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-3269
Practice Address - Country:US
Practice Address - Phone:913-682-1870
Practice Address - Fax:913-682-1775
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist