Healthcare Provider Details

I. General information

NPI: 1629988514
Provider Name (Legal Business Name): BAYLEE MCDONALD BRADLEY CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BAYLEE MCDONALD

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 OLD BROWNSVILLE RD
GALLAWAY TN
38036
US

IV. Provider business mailing address

802 WE ROSS PKWY
SOUTHAVEN MS
38671-8602
US

V. Phone/Fax

Practice location:
  • Phone: 901-867-8575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9162
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: