Provider Demographics
NPI:1730705534
Name:BAILEY, SALLIE (AUD)
Entity type:Individual
Prefix:
First Name:SALLIE
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 RED TAIL RD
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:CO
Mailing Address - Zip Code:80615-8242
Mailing Address - Country:US
Mailing Address - Phone:970-397-8678
Mailing Address - Fax:
Practice Address - Street 1:2018 35TH AVE STE A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3967
Practice Address - Country:US
Practice Address - Phone:970-330-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD.0001015231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist