Provider Demographics
NPI:1750122941
Name:LIERZ, BAILEY JO
Entity type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:JO
Last Name:LIERZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 E WICHITA AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-2444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:331 5TH ST
Practice Address - Street 2:
Practice Address - City:BAILEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:66404-9405
Practice Address - Country:US
Practice Address - Phone:785-294-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician