Healthcare Provider Details

I. General information

NPI: 1700211067
Provider Name (Legal Business Name): LOUISE BAILEY SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S LAUREL ST
PINE BLUFF AR
71601-4859
US

IV. Provider business mailing address

620 S LAUREL ST
PINE BLUFF AR
71601-4859
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-4900
  • Fax: 870-534-4906
Mailing address:
  • Phone: 870-534-4900
  • Fax: 870-534-4906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7026-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: