Provider Demographics
NPI:1679245658
Name:ANDRI, BAILEY
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:ANDRI
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 1:6776 LAKE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-1192
Mailing Address - Country:US
Mailing Address - Phone:651-784-7007
Mailing Address - Fax:651-784-7007
Practice Address - Street 1:2555 COUNTY ROAD E E # 102
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-4906
Practice Address - Country:US
Practice Address - Phone:651-683-2953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10501235Z00000X
MN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist