=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457427338
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAILEY SPEECH AND LANGUAGE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2006
-----------------------------------------------------
Last Update Date | 03/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 735 LONGLEAF BLVD SUITE A
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30045-8460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-995-2378
-----------------------------------------------------
Fax | 678-377-9272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 735 LONGLEAF BLVD SUITE A
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30045-8460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-995-2378
-----------------------------------------------------
Fax | 678-377-9272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MS. BEVERLY S. BAILEY
-----------------------------------------------------
Credential | M.S.
-----------------------------------------------------
Telephone | 770-995-2378
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLP000710
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------