Healthcare Provider Details

I. General information

NPI: 1063377133
Provider Name (Legal Business Name): BAILEY TOSTLEBE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 SW STATE ST
ANKENY IA
50023-2555
US

IV. Provider business mailing address

PO BOX 736706
CHICAGO IL
60673-6706
US

V. Phone/Fax

Practice location:
  • Phone: 319-382-9318
  • Fax: 855-915-0244
Mailing address:
  • Phone: 317-502-3512
  • Fax: 855-915-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-436334
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: