Healthcare Provider Details

I. General information

NPI: 1750122941
Provider Name (Legal Business Name): BAILEY JO LIERZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 5TH ST
BAILEYVILLE KS
66404-9405
US

IV. Provider business mailing address

1649 61ST ST
BROOKLYN NY
11204-2746
US

V. Phone/Fax

Practice location:
  • Phone: 785-294-2012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0657
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number00749
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: