Provider Demographics
NPI:1962250589
Name:HOUSTON, BAILEY ANN
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:ANN
Last Name:HOUSTON
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 1:2042 WOODDALE DR STE 125
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4394
Mailing Address - Country:US
Mailing Address - Phone:651-689-3007
Mailing Address - Fax:651-369-2904
Practice Address - Street 1:2042 WOODDALE DR STE 125
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4394
Practice Address - Country:US
Practice Address - Phone:651-689-3007
Practice Address - Fax:651-369-2904
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical