Provider Demographics
NPI:1861529976
Name:BAILEY, REBECCA JO (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JO
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JO
Other - Last Name:FUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5220
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-5220
Mailing Address - Country:US
Mailing Address - Phone:253-520-1800
Mailing Address - Fax:253-373-1700
Practice Address - Street 1:950 PACIFIC AVE STE 1025
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4469
Practice Address - Country:US
Practice Address - Phone:253-520-1800
Practice Address - Fax:253-373-1700
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000055741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical