Healthcare Provider Details

I. General information

NPI: 1801013966
Provider Name (Legal Business Name): MRS. CAROL BAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PEACH LN
NEW BADEN IL
62265-1107
US

IV. Provider business mailing address

201 PEACH LN
NEW BADEN IL
62265-1107
US

V. Phone/Fax

Practice location:
  • Phone: 618-977-7906
  • Fax: 618-588-3559
Mailing address:
  • Phone: 618-977-7906
  • Fax: 618-588-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: