Provider Demographics
NPI:1528633534
Name:BAILEY, HEIDI
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:BAILEY
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 1:3975 KENNETH DR.
Mailing Address - Street 2:
Mailing Address - City:ROOTSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44272
Mailing Address - Country:US
Mailing Address - Phone:330-850-5141
Mailing Address - Fax:330-850-5349
Practice Address - Street 1:3975 KENNETH DR.
Practice Address - Street 2:
Practice Address - City:ROOTSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44272
Practice Address - Country:US
Practice Address - Phone:330-850-5141
Practice Address - Fax:330-850-5349
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1063909612Medicaid