Provider Demographics
NPI:1881292209
Name:EDWARDS, BAILEE
Entity type:Individual
Prefix:
First Name:BAILEE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BAILEE
Other - Middle Name:
Other - Last Name:KOOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1525 31ST AVE SW STE C2
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-2016
Mailing Address - Country:US
Mailing Address - Phone:701-857-4410
Mailing Address - Fax:
Practice Address - Street 1:1525 31ST AVE SW STE C2
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-2016
Practice Address - Country:US
Practice Address - Phone:701-857-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist