Provider Demographics
NPI:1548823438
Name:BLAIR, BAILEY ANN
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:ANN
Last Name:BLAIR
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 1:555 N WOODLAWN ST STE 3105
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3673
Mailing Address - Country:US
Mailing Address - Phone:316-651-1815
Mailing Address - Fax:
Practice Address - Street 1:555 N WOODLAWN ST STE 3105
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3673
Practice Address - Country:US
Practice Address - Phone:316-651-1815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9185104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
14446991OtherCAQH