Provider Demographics
NPI:1326879073
Name:DEVLIN, BAILIE
Entity type:Individual
Prefix:
First Name:BAILIE
Middle Name:
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 STRASSNER DR UNIT 2101
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1884
Mailing Address - Country:US
Mailing Address - Phone:217-415-0700
Mailing Address - Fax:
Practice Address - Street 1:1251 STRASSNER DR UNIT 2101
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-1884
Practice Address - Country:US
Practice Address - Phone:217-415-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023041792133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered