Basic Information
| Provider Information | |||||||||
| NPI: | 1053780775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'BRIEN | ||||||||
| FirstName: | BAYLEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1316 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CLARION | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505252019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5155322811 | ||||||||
| FaxNumber: | 3193431161 | ||||||||
| Practice Location | |||||||||
| Address1: | 1089 JORDAN CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | WEST DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502665829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5153272000 | ||||||||
| FaxNumber: | 5153272019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2015 | ||||||||
| LastUpdateDate: | 04/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 078285 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.