1770178618 NPI number — BAILEY WEBB SLP

Table of content: BAILEY WEBB SLP (NPI 1770178618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770178618 NPI number — BAILEY WEBB SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBB
Provider First Name:
BAILEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCOTT
Provider Other First Name:
BAILEY
Provider Other Middle Name:
KATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770178618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9225 UNIVERSITY BLVD STE E2C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29406-9149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-569-4546
Provider Business Mailing Address Fax Number:
843-569-4535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9225 UNIVERSITY BLVD STE E2C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-9149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-569-4546
Provider Business Practice Location Address Fax Number:
843-569-4535
Provider Enumeration Date:
03/03/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  4705 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 7506 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)