Healthcare Provider Details

I. General information

NPI: 1437801644
Provider Name (Legal Business Name): HANNAH BAILEY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 W LAKE ST STE 2S
CHICAGO IL
60661-1034
US

IV. Provider business mailing address

1749 N WELLS ST APT 1207
CHICAGO IL
60614-5826
US

V. Phone/Fax

Practice location:
  • Phone: 773-692-6525
  • Fax: 773-692-6525
Mailing address:
  • Phone: 785-840-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. HANNAH GRACE BAILEY
Title or Position: OWNER/THERAPIST
Credential: LCPC
Phone: 785-840-4156