Provider Demographics
NPI:1144908021
Name:BLAISDELL, BAILEY A (MA, SLP)
Entity type:Individual
Prefix:MS
First Name:BAILEY
Middle Name:A
Last Name:BLAISDELL
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 N STATE ST APT S6
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1270
Mailing Address - Country:US
Mailing Address - Phone:989-590-2302
Mailing Address - Fax:
Practice Address - Street 1:1111 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2054
Practice Address - Country:US
Practice Address - Phone:734-764-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist