Provider Demographics
NPI:1073330684
Name:ACKERMAN, BAILEY LANE (MSW)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:LANE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:LANE
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4613
Mailing Address - Country:US
Mailing Address - Phone:580-436-5111
Mailing Address - Fax:
Practice Address - Street 1:625 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4613
Practice Address - Country:US
Practice Address - Phone:580-436-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor