MEDICARE: MR. ANDREW S BAILEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	8383-123	WI

General Provider Information

NPI Number	:	1043683451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW S BAILEY LCSW

Provider Business Mailing Address
First Line	:	515 W NORTH SHORE DR STE 101
Second Line	:
City	:	HARTLAND
State	:	WI
Zip	:	53029-8365
Country	:	US
Telephone Number	:	262-682-3147
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 W NORTH SHORE DR STE 101
Second Line	:
City	:	HARTLAND
State	:	WI
Zip	:	53029-8365
Country	:	US
Telephone Number	:	262-682-3147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2015
Last Update Date	:	11/07/2025

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