Healthcare Provider Details

I. General information

NPI: 1053474650
Provider Name (Legal Business Name): WENDY BAILEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FLYNN DR
MILBANK SD
57252-1508
US

IV. Provider business mailing address

301 FLYNN DR
MILBANK SD
57252-1508
US

V. Phone/Fax

Practice location:
  • Phone: 605-432-4587
  • Fax: 605-432-4580
Mailing address:
  • Phone: 605-432-4587
  • Fax: 605-432-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY002609
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number569
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: