Provider Demographics
NPI:1679298848
Name:BAILY, ABIGAIL ROSE (PHD)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:ROSE
Last Name:BAILY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-6922
Mailing Address - Country:US
Mailing Address - Phone:702-382-6770
Mailing Address - Fax:702-382-3998
Practice Address - Street 1:716 S 6TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-6922
Practice Address - Country:US
Practice Address - Phone:702-382-6770
Practice Address - Fax:702-382-3998
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY1090103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist