Provider Demographics
NPI:1720655723
Name:REYNOLDS, BAILEY (AUD)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8521 E FLORENTINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8954
Mailing Address - Country:US
Mailing Address - Phone:928-227-0717
Mailing Address - Fax:
Practice Address - Street 1:8521 E FLORENTINE RD STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8954
Practice Address - Country:US
Practice Address - Phone:928-227-0717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA13091231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist