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NPI Code Detail

MEDICARE: MRS. TARA YVETTE BAILEY M.A., CCC-SLP

MEDICARE: MRS. TARA YVETTE BAILEY M.A., 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
1235Z00000XSpeech-Language Pathologist
2235Z00000XSpeech-Language Pathologist146-005649IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12086576OTHERILISBE

General Provider Information

NPI Number : 1134399777
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TARA YVETTE BAILEY M.A., CCC-SLP
Provider Business Mailing Address
First Line : 42 W MADISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60602-4309
Country : US
Telephone Number : 773-573-3104
Fax Number :
Provider Business Practice Location Address
First Line : 42 W MADISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60602-4309
Country : US
Telephone Number : 773-573-3104
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2008
Last Update Date : 03/17/2018

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