MEDICARE: BAILEY LONG SLP

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1669115044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY LONG SLP

Provider Business Mailing Address
First Line	:	504 BEVERLY DR
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-2603
Country	:	US
Telephone Number	:	817-600-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 HULEN ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76107-7277
Country	:	US
Telephone Number	:	817-569-4039
Fax Number	:

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

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	07/12/2023

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Directions to “ BAILEY LONG SLP” Practice Location

Language	Start Address	Practice Location

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