Provider Demographics
NPI:1811734460
Name:CHATHAM, BAILEY NOEL
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:NOEL
Last Name:CHATHAM
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 1:5658 WATERFORD CIR
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-0706
Mailing Address - Country:US
Mailing Address - Phone:440-622-4421
Mailing Address - Fax:
Practice Address - Street 1:3410 STILLWATER DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-6224
Practice Address - Country:US
Practice Address - Phone:330-416-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician