Provider Demographics
NPI:1730223041
Name:BAILEY, JENNIFER L (LAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4063 DEER CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-4275
Mailing Address - Country:US
Mailing Address - Phone:608-868-3005
Mailing Address - Fax:
Practice Address - Street 1:11673 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-9549
Practice Address - Country:US
Practice Address - Phone:815-623-7694
Practice Address - Fax:815-623-9689
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist