MEDICARE: MISS COLLEEN ELIZABETH BAILEY MS, RDN, LD

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	133V00000X	Registered Dietitian	LD.09516	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LD.09516	OTHER	OH	STATE MEDICAL BOARD OF OHIO
2	86175731	OTHER		COMMISSION ON DIETETIC REGISTRATION ID

General Provider Information

NPI Number	:	1346997772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS COLLEEN ELIZABETH BAILEY MS, RDN, LD

Provider Business Mailing Address
First Line	:	4182 WORTH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-1535
Country	:	US
Telephone Number	:	614-300-0116
Fax Number	:	614-455-9311

Provider Business Practice Location Address
First Line	:	4182 WORTH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-1535
Country	:	US
Telephone Number	:	614-300-0116
Fax Number	:	614-455-9311

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

Provider Enumeration Date	:	03/06/2022
Last Update Date	:	05/30/2025

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