Basic Information
| Provider Information | |||||||||
| NPI: | 1497882203 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MSCCCSLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3183 CHURCHVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152274342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126680401 | ||||||||
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| Practice Location | |||||||||
| Address1: | 135 CUMBERLAND RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152375447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123641886 | ||||||||
| FaxNumber: | 4123647120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 05/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL007950 | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 101360746 | 05 | PA | MEDICAID |