Healthcare Provider Details

I. General information

NPI: 1417869652
Provider Name (Legal Business Name): KELLY BAYLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PRATT RD
METAMORA MI
48455-8910
US

IV. Provider business mailing address

6638 GLEN RIDGE CT
CLARKSTON MI
48348-5021
US

V. Phone/Fax

Practice location:
  • Phone: 810-538-2345
  • Fax:
Mailing address:
  • Phone: 315-521-7742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101000357
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: