Provider Demographics
NPI:1053955195
Name:STAAB, BAILEY JO
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:JO
Last Name:STAAB
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 1:37998 295TH RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:NE
Mailing Address - Zip Code:68869-3034
Mailing Address - Country:US
Mailing Address - Phone:402-469-9282
Mailing Address - Fax:
Practice Address - Street 1:201 N STATE HWY 11
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NE
Practice Address - Zip Code:68824
Practice Address - Country:US
Practice Address - Phone:308-485-4258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist