MEDICARE: AMY NICOLE BAILEY LMSW

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	1041C0700X	Clinical Social Worker	6801090165	MI

General Provider Information

NPI Number	:	1427451137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY NICOLE BAILEY LMSW

Provider Business Mailing Address
First Line	:	4222 CADDO AVE SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-2436
Country	:	US
Telephone Number	:	616-326-1630
Fax Number	:

Provider Business Practice Location Address
First Line	:	959 LAKE DR SE
Second Line	:	SUITE 6
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-1447
Country	:	US
Telephone Number	:	616-326-1630
Fax Number	:

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

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	05/17/2022

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Directions to “ AMY NICOLE BAILEY LMSW” Practice Location

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