Basic Information
| Provider Information | |||||||||
| NPI: | 1992286256 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | BAILEA | ||||||||
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| Credential: | MCD, SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5437 EISENHAUER RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782183703 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5437 EISENHAUER RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782183703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106469576 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2018 | ||||||||
| LastUpdateDate: | 08/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 114098 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 114098 | 01 | TX | TEXAS DEPARTMENT OF LICENCING AND REGULATION- SLP LICENSE | OTHER |