Provider Demographics
NPI:1598457764
Name:BAILEY, CHRISTY JADE (CERT HAIR LOSS SPEC)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:JADE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CERT HAIR LOSS SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260TH E 312TH
Mailing Address - Street 2:UNIT 5223
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095
Mailing Address - Country:US
Mailing Address - Phone:440-703-1048
Mailing Address - Fax:
Practice Address - Street 1:7537 MENTOR AVE STE 207B
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5464
Practice Address - Country:US
Practice Address - Phone:260-639-4247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101915OtherOHIO STATE BOARD LICENSE