Provider Demographics
NPI:1851120760
Name:WETHERN, BAILEY MICHELE (LGSW)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:MICHELE
Last Name:WETHERN
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 CARR LAKE RD SW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-8281
Mailing Address - Country:US
Mailing Address - Phone:651-353-9260
Mailing Address - Fax:
Practice Address - Street 1:1297 CARR LAKE RD SW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-8281
Practice Address - Country:US
Practice Address - Phone:651-353-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31791104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker