Provider Demographics
NPI:1962610386
Name:BAILEY, LESLIE MARIE (RSA)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RSA
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:MARIE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RSA
Mailing Address - Street 1:533 CODY LN
Mailing Address - Street 2:
Mailing Address - City:BRAIDWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60408-1775
Mailing Address - Country:US
Mailing Address - Phone:815-671-2140
Mailing Address - Fax:815-795-2111
Practice Address - Street 1:502 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSEILLES
Practice Address - State:IL
Practice Address - Zip Code:61341-1419
Practice Address - Country:US
Practice Address - Phone:815-513-3654
Practice Address - Fax:815-795-2111
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000115246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant