MEDICARE: BAILEY HAGEDORN

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	P022728	NC

General Provider Information

NPI Number	:	1831077619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY HAGEDORN

Provider Business Mailing Address
First Line	:	10706 SIKES PL STE 275
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-8015
Country	:	US
Telephone Number	:	704-577-4071
Fax Number	:

Provider Business Practice Location Address
First Line	:	14835 BALLANTYNE VILLAGE WAY STE 225
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-4317
Country	:	US
Telephone Number	:	704-577-4071
Fax Number	:

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

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	08/21/2025

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Directions to “ BAILEY HAGEDORN ” Practice Location

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