Healthcare Provider Details

I. General information

NPI: 1659206845
Provider Name (Legal Business Name): ALLYSON BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLY BAILEY

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1567 SW CHANDLER AVE STE 100
BEND OR
97702-3257
US

IV. Provider business mailing address

11407 ELMSTONE CT
SAN DIEGO CA
92131-3760
US

V. Phone/Fax

Practice location:
  • Phone: 541-588-6350
  • Fax:
Mailing address:
  • Phone: 858-999-7934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18815
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: