Provider Demographics
NPI:1770949042
Name:BAILEY, JODI (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 MISSISSIPPI AVE SE APT 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2459
Mailing Address - Country:US
Mailing Address - Phone:845-239-9292
Mailing Address - Fax:
Practice Address - Street 1:3400 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1542
Practice Address - Country:US
Practice Address - Phone:202-279-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-02
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3991235Z00000X
DCSLP001195235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist