Provider Demographics
NPI:1053700039
Name:DEGROAT, BAILEY ALYSE (MCD)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:ALYSE
Last Name:DEGROAT
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7328
Mailing Address - Country:US
Mailing Address - Phone:501-305-3305
Mailing Address - Fax:501-279-0760
Practice Address - Street 1:118 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7328
Practice Address - Country:US
Practice Address - Phone:501-305-3305
Practice Address - Fax:501-279-0760
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist