Provider Demographics
NPI:1902137490
Name:BAILEY, CORINNE B
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:B
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 W COMMERCIAL ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4799
Mailing Address - Country:US
Mailing Address - Phone:207-874-1065
Mailing Address - Fax:207-874-1068
Practice Address - Street 1:75 W COMMERCIAL ST STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-874-1065
Practice Address - Fax:207-874-1068
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MESP1717OtherSTATE OF MAINE