Provider Demographics
NPI:1053732131
Name:BAILEY, AMANDA PAIGE (SLP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:PAIGE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:PAIGE
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:315 E CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-8238
Mailing Address - Country:US
Mailing Address - Phone:575-393-0755
Mailing Address - Fax:575-393-0249
Practice Address - Street 1:315 E CLINTON ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-8238
Practice Address - Country:US
Practice Address - Phone:575-393-0755
Practice Address - Fax:575-393-0249
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP5815235Z00000X
NM47652355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant