Healthcare Provider Details

I. General information

NPI: 1548123367
Provider Name (Legal Business Name): BAILEE SOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 W CLARK RD STE 100
YPSILANTI MI
48197-0860
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR # J
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 734-434-3060
  • Fax:
Mailing address:
  • Phone: 734-747-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801120861
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: