Provider Demographics
NPI:1144294141
Name:BAILEY, TERESA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:4815 N ASSEMBLY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6197
Mailing Address - Country:US
Mailing Address - Phone:509-434-6312
Mailing Address - Fax:509-434-7113
Practice Address - Street 1:4815 N ASSEMBLY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6185
Practice Address - Country:US
Practice Address - Phone:509-434-6312
Practice Address - Fax:509-434-7113
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00008486104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8856571Medicare ID - Type Unspecified