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NPI Code Detail

MEDICARE: BAILEY NICOLE RUSTAD MA, CCC-SLP

MEDICARE: BAILEY NICOLE RUSTAD MA, CCC-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
1235Z00000XSpeech-Language Pathologist119662IA

General Provider Information

NPI Number : 1821772716
Entity Type Code : Individual
Provider Name (Legal Business Name) : BAILEY NICOLE RUSTAD MA, CCC-SLP
Provider Business Mailing Address
First Line : 5406 MERLE HAY RD
Second Line :
City : JOHNSTON
State : IA
Zip : 50131-1209
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1661 BOYSON SQUARE DR STE 100
Second Line :
City : HIAWATHA
State : IA
Zip : 52233-2392
Country : US
Telephone Number : 319-777-7450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2023
Last Update Date : 01/08/2025

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Directions to “ BAILEY NICOLE RUSTAD MA, CCC-SLP” Practice Location

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