Provider Demographics
NPI:1770204547
Name:PHELAN, BAILEY (MA, SLP)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:PHELAN
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 1:2801 SILKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3132
Mailing Address - Country:US
Mailing Address - Phone:469-826-0577
Mailing Address - Fax:
Practice Address - Street 1:2800 18TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-4603
Practice Address - Country:US
Practice Address - Phone:469-752-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist