MEDICARE: BAILEY ROSE WARSTLER MA SLP CCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	0862	AZ
2	235Z00000X	Speech-Language Pathologist	SLP4633	AZ
3	235Z00000X	Speech-Language Pathologist	SLP.0003344	CO

General Provider Information

NPI Number	:	1295871465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY ROSE WARSTLER MA SLP CCC

Provider Business Mailing Address
First Line	:	1305 KIRKWOOD DR APT 307
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1976
Country	:	US
Telephone Number	:	216-409-4514
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 S. TEJON STREET
Second Line	:	SUITE 1100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2231
Country	:	US
Telephone Number	:	512-399-0064
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	09/01/2022

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