MEDICARE: MS. SUZANNE BAILY RD, CD

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	133V00000X	Registered Dietitian	DI00001873	WA

General Provider Information

NPI Number	:	1427041805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNE BAILY RD, CD

Provider Business Mailing Address
First Line	:	8552 18TH AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-3644
Country	:	US
Telephone Number	:	206-962-1010
Fax Number	:	253-872-3448

Provider Business Practice Location Address
First Line	:	6852 S 220TH ST
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98032-1963
Country	:	US
Telephone Number	:	253-872-3460
Fax Number	:	253-872-3448

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	12/06/2011

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