Healthcare Provider Details

I. General information

NPI: 1346713385
Provider Name (Legal Business Name): LUCY P BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCY PRISCILLA BAILEY CSW

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 S STATE ST STE 250
CLEARFIELD UT
84015-1100
US

IV. Provider business mailing address

189 S STATE ST STE 250
CLEARFIELD UT
84015-1100
US

V. Phone/Fax

Practice location:
  • Phone: 385-423-2377
  • Fax: 385-423-2379
Mailing address:
  • Phone: 385-423-2377
  • Fax: 385-423-2379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5185530-3502
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: