Provider Demographics
NPI:1104596519
Name:LASS DUNGAN, BAILEE (AUD)
Entity type:Individual
Prefix:
First Name:BAILEE
Middle Name:
Last Name:LASS DUNGAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:BAILEE
Other - Middle Name:
Other - Last Name:LASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 E ROSSER AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4457
Practice Address - Country:US
Practice Address - Phone:701-323-8921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1989231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1989OtherNORTH DAKOTA BOARD OF EXAMINERS