Healthcare Provider Details

I. General information

NPI: 1679484661
Provider Name (Legal Business Name): LILLY MARIE BAGBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 S ANKENY BLVD
ANKENY IA
50023-9417
US

IV. Provider business mailing address

101 S RIVERSIDE DR
AMES IA
50010-5961
US

V. Phone/Fax

Practice location:
  • Phone: 515-598-7200
  • Fax:
Mailing address:
  • Phone: 319-433-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: