Provider Demographics
NPI:1144916719
Name:BAILEY, ALYSON CONVERSE
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:CONVERSE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:LESLEY
Other - Last Name:CONVERSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3010 COUNTY ROAD 131
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-3206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3010 COUNTY ROAD 131
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:TX
Practice Address - Zip Code:79562-3206
Practice Address - Country:US
Practice Address - Phone:325-260-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist