MEDICARE: BAILEY GRADDON OLEARY CCC-SLP

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	235Z00000X	Speech-Language Pathologist	14397231	NC

General Provider Information

NPI Number	:	1093591703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY GRADDON OLEARY CCC-SLP

Provider Business Mailing Address
First Line	:	6555 OLD MONROE RD
Second Line	:
City	:	INDIAN TRAIL
State	:	NC
Zip	:	28079-5409
Country	:	US
Telephone Number	:	980-290-1420
Fax Number	:

Provider Business Practice Location Address
First Line	:	6555 OLD MONROE RD
Second Line	:
City	:	INDIAN TRAIL
State	:	NC
Zip	:	28079-5409
Country	:	US
Telephone Number	:	980-290-1420
Fax Number	:

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

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/07/2023

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Directions to “ BAILEY GRADDON OLEARY CCC-SLP” Practice Location

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