Healthcare Provider Details

I. General information

NPI: 1700254521
Provider Name (Legal Business Name): EMILY BAILIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 FOOTHILL BLVD
ROCK SPRINGS WY
82901-5610
US

IV. Provider business mailing address

2300 FOOTHILL BLVD
ROCK SPRINGS WY
82901-5610
US

V. Phone/Fax

Practice location:
  • Phone: 307-352-6677
  • Fax:
Mailing address:
  • Phone: 307-352-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-251
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPCSW-1121
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: