Provider Demographics
NPI:1861114894
Name:BAILEY, MAKENZIE NICOLE
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:NICOLE
Last Name:BAILEY
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 1:5137 OAK SHADE WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4166
Mailing Address - Country:US
Mailing Address - Phone:191-638-5976
Mailing Address - Fax:
Practice Address - Street 1:5137 OAK SHADE WAY
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-4166
Practice Address - Country:US
Practice Address - Phone:191-638-5976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician